51177.11044 ; D ;I yster-Avenue
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'TR EF.I'
TION FOR PLUMBING PERMIT
i a Y OF CUPF.RTINO
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x o Sanitary No.
3 a U: l 4 4 0 1U 196— Permit No
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Fees J XJO
A> h ati s I���(��{yj ((���(�e City of Cupertino fora permit to install plumbing
pi IIWAVI tel0.Ults �'t9�reverse side hereof, and agrees to install said prices
ane or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws,npp4icable thereto.
Use of Premises Residence
Owner Darold S. Axtman
By Soft.master
CONTRACTOR, AGENT
Address 10401, DPrtinster Ave.
1150 Dell Ave.
Phone 329 cncn
State License 214281 Approved
I AV 11 PLUMBING INSPECTOR
'Water
ng
ns
xture
Sprinkler Valves 1 1, 11 Water Sys. Fee
RECORD OF INSPECTION
Underground Rough.
.Partial Rough
Rough. Complete
Main Drain
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