51172V\ J-9 W� 69&22--a+.' ✓A 0" LOT NO,
NO. STREET 0
W z PJrI`I PLUMBING PERMIT
PERTINO
W LL f MAY 1968Pil,
sanitar °'
xo Y° J Date 19Permit No.
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° Application Wherebym �X���53 Gty�'of Cupertino for a permit to null plumbing
o a pipes and/or fixtures listed .on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordanceu-ith the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
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By
GONTRAC7OR,AGENT
Phone ,)- J r11 — J—IJ~I—
State License
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Address
Approved-WILLIH d D. BENEVICH
PLUMBING INSPECTOR
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RECORD OF INSPECTION
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