51167.2 (3)LOT NO.
NO. STPEF.i' f
APPLIC I01, PERMIT
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x o O C T 3 0 .1966;an
o a Date Oct. 2 196 8 Permit No
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w a ��T�' C,I�PE�TI(�0 Fee $ 3.5
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Application is hereby m. a th Ity o uper mo or a permit to install Plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
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a Use of Premises HOUSEHOLD
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3 Owner JOHN R. EVAN Address 21850 RUCKER DR.
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z By SOFT1.1ASTER.INC. Address P.O. BOX 696
O CONTRACTOR,AGENE
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— W Phone 379-505D
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a o State License Approved
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PLUMBING INSPECTOR
rea
ler Val�cs
UNITS I FEES
Boxes
00
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .