234281OT
O. STR F. F.I'
D
�� ATION FOR PLUMBING PERMIT
Z a ITY OF CUPERTINO
w� !SEP
f o `U Sanitary No.3 <�.l�i August 2 1966 Permit No 234261
u I
6I' Pee $ !1=�
Application I'M
T�F�/A{lJ�' to the City, of Cupertino for a Permit to install Plumbing
pipes and/or fixtures hstNon 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 H OUSEHOLD
Owner ORTHELL T. DENNISON Address 10667 FARALLONE AVENUE
SOFTMASTER, INC.
CONTRACTOR,AGENT
Address 1150 DELL AVE., CAMPBELL
W Phone 379 5050
z
w
a
s State License Approved /
U PLUMBING INSPECTOR /
FEES
,rinkler Valvcs
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.Main Drain
Final