51167.1 (3)NO.
APPLICATION FOR
' \I� `,ITY OF
�l
Date r lqF 196_
LC
PLUMBING
CUPERTINO
Sanitary N
Permit
Fee $ a-6 - S-0
Application, islherebymade_to)the�Gty of Cupertino for a permit to install plumbing
pipes and/onfixtutes listed Co`rrlthelreieise 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 ./////C/.//Ywt�
Owner E-�'L�/� / "./ Address '� O
By Z1/1- !/4l/�/f�t4 /.e Address
CONTAAC70R, AGENT
Phone�3a 3
State License c/- in
X
WILLIAM D. bENEVICH
1 PLUMBING INSPECTOR '/
Water Heate
rea
ns
kler Valves
RECORD OF INSPECTION
Underground Rough...
Partial Rough -
Rough. Complete -
Main Drain 'I