511672
NO.
LOT
UMBING PERMIT
CITY Od9PERTINO
fAPR 30 191 )I Sanitary No.
7
Date I 1969^ Permit NoY (I. -//( 7
••( , CUPE'RTIN'o Fee $ 3 i
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 laXs applicable thereto.
Use of Premises
State License '�/41/ L E/
Address-
Address
ddress Address
Approved
PLUMBING INSPECTOR
FEES
kler
RECORD OF INSPECTION
Underground Rough...
Partial Rough--
Rough. Complete -
Main Drain
Final---