51167 (2)N Q
w�
/ I 1 O 9 I Q,t� LOT
NO. S"EE.I'
Date?'A,�PPLv�ICATION FOR
tea �i CUTY0OP
APR 1? 1968 ��,A6_
PLUMBING PERMIT
CUPERTINO
sanitary i\'u.
Permit No, —%
Pee $ O
ApWliIY, Oi Fhcr%JPfRTjf,t�it)' of Cupertino for a permit to install plumbing
Pipes and/or fixtures I[Ste Oil t to 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, anti all other laws phcable thereto.
i
Use of Premises Z
U p
OwneiYYVL-a Yyw - r�.a-�'.e� R. Address
By 'Yhn-e+.p�A 1�'-r-w-c.lro Address
CONTRACTOR, AGENT
Phone "Z / A/-( r
State License Approved""__""' r
it PLUMBING INSPECTOR
Water Heate
rams
ze
RECORD OF INSPECTION
PEES