2091 LOT Nn._ 7
NO. STRR.R.'I'
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPIiRTINO
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3 a Date -3 ' 620 196-5 Permit No.
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
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
a w Cupertino, and all other laws applicable thereto.
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Use of Premises 10e .
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3 F ONTR.TCTOR, AGENT
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Y State Licenseo- ApprovedWILL1AM D. 13ENEVICH
PLUMBING, JN$p�',L��pR
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Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
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❑ Sewer Connection tJ Z Z-
Sanitary Permit No. ..-.-._.. .........._.....------
/Plumbing Final Plumbing Permit No.
Lot No. .... ..•j.. .-.
Owner or Tenant --.-..
At
Tract ..........-. .---G .
-.... ..._.-------------------............... ......
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Date Connected ------..----..._- ------ .2.7........ ........ . ....... . ...... 19-413
DateFinal ----------------------- --- ------- ------ ._--....
...... . _... ---- .... ..
PLUMBING INSPECTOR
111 7/61-300