2445LOT NO. 14
S F.
D P TI .FOR PLUMBING PERMIT
1 OCT 3 1963 Y OF CUPERTINO
Sanitary No.
Date—' C — 1963 Permit No.T
CITY 0 Fee $
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 t' `i 1i7��2 c/ Address
$y
CONTRACLOR, AGENT
Phone�/��•��3�-3
State License
Address
Approved ! /
PLUMBING�I175PECCO¢A
Sewer
W
rea
UNITSI FEES
�prfnklcr vai,cs I 1 11 Water Sys. Fee I/
RECORD OF INSPECTION
Underground Rough... / `,-3
.Partial Rough- I. --:-z- Z /
.Rough Complete-
H,
omplete_
\lain Drain;