51175NO! STREET
® C
19E8 � OR
c F
Y 16
Date 196_
1014
PLUMBING PERMIT
CUPERTINO
Sanitary No.
Permit
,,TT (� ��[�T f� Fee S 3.50
App'Ydtyn Isf�ierc-0,03\d ��`T:ity 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
Owner Mrs. B. D. Jenes Address 19669 Hale P1
By Rayne Dater Conditioning
CONTRACTOR,AGENT
Phone 967-4545
State License C26-165269
�u
Address 243—B Moffett Blvd.
Mt. Viewl Uallf.
94040
PLUMBING INSPECTOR
rea
ler
ins
I UNITS I FEES II IUNITSI FEES
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final