51167.1ar,;77U l'r� :� nl NO. i
No. ST EEI'
APPLICATION FOR PLUMBING PERMIT
z i a CITY OF CUPERTINO
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Sanitary Nu�LLoaDate6 Permit No S ��G% %73 u Fee S ��J Ap}j � anoity of Cupertino For a permit to install plumbing
01 pipes and/br fixtures listed on the reverse side hereof, and agrees to install said prices
> and �r .r�r a e provisions of the PlumbingCode of the City of
a w Cupct2i�h Tang E citl}r. IMiJ h Ubtthereto. }
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LL Use of Premises f
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3 Owneu,X C&X • Address
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B}'00.Address 1-1-74Z %
n CONTRACTOR, AGENT
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Phone
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Q o State License /./G 59 7ApprovedlLL1AP1 D. CENEVICH
.,, u PLUMBING INSPECTOR ✓
FEES
Water Beate
xture
ns
Ller Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final .