51167.1N Q
LOT NO. 6
NO. STREET
APPL-I,CATION .FOR PLUMBING PERMIT
OF, CUPERTINO
1
Sanitary NO.
Date r' } 1967 11962 Permit No
Fee$.73.s�
Applicati(TVs h'er'eby made)`oFfhejGq 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
OwnevO./!1 �hLL Address
By ��� /7 - Address
CONTRACTOR, AGENT
Phone 'S�'�J x'-321
State License/
WILLIAM ^ PrnIF_VICH
Approved
PLUMBING INSPECTOR ,/
X
Ines
Fee
nkler Valves
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final.._ �.