2664LOT NO.
NO. Q TR 0
VmAR
FOR PLUMBING PERMIT
i+OFCUPERTINO
o 27 1964 Sanitary No.
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< Date ,., 196' � Permit No
CITY OF CUPERTiNO Fee $ > ri/v
O Application is hereby made to the City of Cupertino for a permit tc instal
o a 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
a w Cupertino, and all other laws applicable thereto.
Use of Premises
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J CONTRACTOA, AGENT
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^ State Lics�
Approved «M<0
PLUMBING INSPECTOR
Vater Heater
reit
kler Vaivcs
Sewer
WA'
Size
FEES