1781 1067 Y YVILIAA Th(J /Q// LOT NO. /
NO. STREET
APPL'ICppA'ION FOR PLUMBING PERMIT
SEP 5 1J6G ,OF CUPERTINO
KEP 5 1
Date195— Permit No. ` 7 /
y CITY r I '
Fee $
Application is hereby made to the City 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 (aJpplicablee thereto.
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Use of Premises "�L.l�,.�.cX-
Own V—k Address
By Address
CONTRACTOR, AGENT
Phone�C Y a — f Q 0 ATpproved `
PLUMBING INSPW
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Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
C] Sewer Connection Sanitary Permit No. _.. .�0
Plumbing Final Plurnbing Permit No. ..12 ----------------
Lot -- -"---
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Date Connected -------...-------1.. ..7407 ./............--- ..... 19.5//P.++���
Date Final
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PLUMBIN�Q INSPEC
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111 7/61-500 -