1395 /O (O 7,f LOT NO.
NO. STREET
® �APPLICATION FOR PLUMBING PERMIT
�� [jfiT'Y
OF CUPERTINO ,C�Date �AN K q 1962 1-4-7s Permit No. ),39.
O
M CITY OF CffffINQ Fee i 7 --
Application is here y-made o 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
y Cupertino, and all other laws applicable thereto.
tl
°i Use of Premises
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N Owne!Cd
Address
BY _ Address
CONTRACTOR, AGENT D I '
Choneq 0 _ Approved
' PLUMBING INSPECTOR
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till - Cupertinn Sanifary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No. .....
Plumbing Final Plumbing Permit No. . �
- - --
l --- - ---..
Lot No. .../�
Owner or Tenant ....
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Tract ------------
Date
------- "Dnte Connected .......................... .�Q..........................-_------------------------------ 1 �-
Date final -------..-- --.... .. d �L
..-.........----.__....-------.- ---- 19 --7
..... .------.._---_.......
"- .UA(IiING INSPEC'T'OR
LLI t/GO-S00