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V APPLICATION rFOR PLUMBING PERMIT
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' 0 Sanitary No.
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o Application is hereby made to the City of Cupertino for a permit to install plumbing
0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i - and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other aws applicable thereto.
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ao State License %S/ �?a Approved '� �✓ �
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PLUMNiN�G INSPECTp�A
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BUILDING INSPECTOR'S OFFICE
CITY OF CUPGRTINU
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❑ Suer Connection % Sanitary Permit No. ..-a7.<............
Plumbing Fin Plumbing Permit No. . ; l.s............
of No
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Date Connected ............................ ..
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Date Final ..................................................��.-...:J:.=- c�I;� 19-'L......
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Ill 7/63-IM
PLUMBING INSPBCPOR\
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