2093 �/ 1 q//N, C4(114"i6a".2 � LOT Nn._
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPIIRTINO
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Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
iand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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3CONGTRACTOR, AGENT
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�� Y3�� WILLIAM D. 6ENEVICH
a tate Licens Approved
PLUMBING INSPECTOR
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Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No. ---../5..��l..prZ..- -__,
'/Plumbing Final Plumbing Permit No.
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Date Connected ---------------------
---..----- - ---....---..._ 19_/Q.3
Date Final -----------------------
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PLUMBING INSPECTOR
111 7/61-500