5119yTo 6 F V C/,//- et /V / // Lor NO.
NO.
n OR PLUMBING PERMIT
z < Y CUPERTINO
MAY I 3 1966 Sanitary No.
2
o j Date Permit No
" - .5-1135
�
3` OFw w T Fee $
o aPFQ
w w Application is hereby madZ'tAky of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
_o o Use of Premises eel
/ZfOpti
>M;77/
//
3 Ownerf7 U.Ch Address
zBy /V 7"Ty� /�<y / Address S�2iX
3 0 CONTRACTOR! AGENT
— uai Phone e-11
w z
a boy State License 1:90 }0 Approved
:I PLUMBING INSPECTOR
FEES
Water Heate
ns
rinkler Valves
A
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final