51157 (5)/O//O �fi6: Soi' ScrrisY�ld .Peo�
OT
NO. STR F. F.1'
® CjC FOR PLUMBING PERMIT
OF CUPERTINO
�JUL.13 1965 sanitary No. _
Date � A" l96-!;:-!:5> Permit No `� �� �7
TY (/►Q�jF CgPE ff 1N Fee $
YfiYatil is hereby made to tie City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and ag s to insta said prices
and/or fixtures in acco dance with the provisions of the Plu � �e o le City of
Cupertino, and all o*rtlaws applicablc,llereto. 7/ A
Use Of
Owner Add
Add
Address 2c'O to OO�C�xr�c .+ri+a-,u�eGd
0 13y�&�/ PiPG/i/>G. Tic.
3 F CO NTRACTOR, AGENT
- Phone 7- 15Z/
w z WN
rc a
Q n rState Licens�42 - 207.390 Approved
PLUMBING INSPECTOR
I UNITS I FEES II IIINITSI FEES
Boxes
ns
Sprinkler Valves I 1 II Water Sys. Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final