51140 (2)/0
LOT NO.
NO. STREET
D FOR PLUMBING PERMIT
'
OF CUPERTINO
TJUN A 1965 Sanitary No.
Uate �/ (�F rI IP�RTINn196_ Permit No//� �O
rectiNS M2tSy tTISdE fA TR Pee $ "7�r
� i , do s h e City of Cupertino for 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 Erns applicable thereto.
Use of Premises
Owner— "riS �.,� COU /C/nye Address
r
,�(//
� o By /'�'r�-'` C,—nt✓l.� Address
3 F CONTRACTOR, AGENT
—m Pho�z 9 O .
w Z
ao \State License Approved ��
U1 PLUMBING INSPECTOR
Water Heate
vatunes
011,11
Area Drams I 1 II Main Drain Fee 1 _9_ c==
Icr Vo
Pa
incl
RECORD OF INSPECTION