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D �I OR PLUMBING PERMIT
OF CUPERTINO
f APR 4 1966 Sanitary No.
A `
Date 'ir/"` f , 196 Permit No—
CITY OF CUPERTINO Fee
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 laws applicable thereto.
Use of Premises P/J2r'S � / 7 `/
Owner 5., o J e p 4' s C �+ -c Address
F_ S,, L f3G.2G
CONTRACTOR, AGENT
Phone 2-y3-7LG6
State License t 7C q6
Address s' % f l'f'17Ae,e. J"' ,f L,
Approved
PLUMBING INSPECTOR
aste
rea
Icr Valves
I UNITS I FEES II IUNITSI FEES
Y
Boxes
Storm Drain
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\lain Drain
Final