100006IOLS( 1.4n� (,J� LOT NO.
NO. SnIAT
APPLICATION FOR PLUMBING PERMIT
W 4 CITY OF CUPERTINO
z
r o Sanitary No.
0 Date /a/s 1964 Permit No ,/00 ddb
W LL Fee $ ��
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o` a 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
a w Cupertino, and all other laws applicable thereto,
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Use of Premises '4� .t
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3 Owner A" &,00C .. /moi Address / a G S le LJ o.,
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Z By 52.E . AddressIV;2-1/ /t� 1r"+/at,�
O CONTRACTOR, AGENT
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3 < fry �v
— `w Phone SSL— 2 SGS
37f- iq " l
ao State License ;sp ZApproved
—0 PLUMBING INSPECTOR
I UNITS I FEES II 1UNITSI FEES
Boxes
rea
Sprinkler Valves I I II Water Sys. Fee
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final ---