1482IO_( l� /S�C�C�K�G.G/T_.'-/_/�_S_/ LOT NO.
NO. STREET
APPLII[ON FOR PLUMBING PERMIT
m C SOF CUPERTINO
Date ® ��� 7� Permit No. /44�
''n�� ppT'' ^^'' jj�� A� �o
T ApplfAatl h ioereQ eft�oltfk�L73ty of Cupertino for a permit to install plumbing
pipes a�iVor 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 applicable thereto.
Use of Premises
a
Owner Address
BY _ Address
n CONTRAC R, AGENT
Phone l�� 90 Approved I
16MBING INSPECTOR
MMM=M M
7
! Bldg: Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
s�
❑ Sewer Connection Sanitary Permit No..... a F1 -p
----------
Plumbing Final Plumbing Permit No. ! /�'�"
..... _ ....-----------
Lot o.....
Owner or Tenant ..... ........_............_ �/
Tract,-` ..Q. ..... . ....... .................... P ---------- _ ....... ......
Date Connected .......... ........ ---6 Ll>L
DateFinal ----------- --. ..<. ..__.. _....................._..........-.. 19-a —
PLUMBING INSPECTOR
111 7/61-500