1049ao -711 I , /1� / / R N LOT NO
No.. TRe T '1 1
APPLICATION FOR PLUMBING PERMIT'
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Dat�gu� FF] OP CUPERTINO
1N + )
e Q9W L Permit No.
t Fee$ /�2S
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 applicable thereto.
Use of Pr mises
Owner Address
By- "` _ Address z�
CgNTRACTOR, AGENT
Phon S O O 'O Approve
1 , PLUMBING INSPECTOR
A
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in
Cupertino Sanitary
Ci`ice Copy
IR l BUILDING INSPECTOR'S OFFICE \
CITY OC CUPERTINO
El Sewer Connection Sanitary Permit No.-.�.%d...
�JPlumbing Final L
- � Plumbing Icnnh No..�.C�...._-...........
Lot No....p�l...���.. c.._,,-..�..
Owner or Tenant ._� .. . �.(.....'.-C-...,
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Tract----...---....--.......--......_.............._.___----..
Date Connected .... - - ....._....... ../O
19
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DateFinal ------------ ........ -_---.._..../--------------__... 19..
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t.UNtniNG INSpecrOR