51167.1No.STNEP.T
�APPLICATION FOR PLUMBING PERMIT
DEC 1 1967 cJY OF CUPERTINO
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f o Sanitary No.
p 4
Date 1962 Permit No 5//6-71/
GI.ly til- IJU-I L'iKIIKV Fee $o26 Sy
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.
MLLIAIA D. SENEVICH
State License ��G.r`%� Approved
PLUMBING INSPECTOR
FEES
rea
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final._.