51158 (10)// —. • r �•/�!c. c%c./ {� / I LOT NO.
NO. �TR1�
AP?XICATIONI FOR PLUMBING PERMIT
C OF CUPERTINO
DEC 6 1965 Sanitary No. A
Date C 1 196— Permit No
C TY OF CUPERTINO Fee 5 a
Application is hereby made to the City of Cupertino for a permit to install plumbing;
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code Of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner
By K"LIR! E
CONTRACTOR, AGENT
Address/ r4-0 Q/6 -+-c�
Address 7YS S)K-
Phone 3G�—
State Licensee/�����5 Approved
PLUMBING INSPECTOR (/
FEES
Water Heate
�Gp
k1, Valves
xture
Boxes
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Main Drain
Final