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N `AP.PLIC�rATION FOR PLUMBING PERMIT
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° Application is hereby made to the City of Cupertino for a permit to install plumbing
a a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i- and/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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PLUMBING INSPECTOR
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BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
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❑ Sewer Connection Sanitary Permit No.........
:..'..:...............
Plumbing Final Plumbing Permit No. ....c:..`_::..... .........
lp , Lot No..- .............................
Owner or Tenant .....At
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Tract ..................................... .:-.,<..�:....,.:�,=�- - .........-..-.......... ..
DateConnected ....................................5.:-�'------:--..�. ..............-- ...... 19.M
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Date Final — 19......
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Ill 7/6;-tM PLUMBING INSPE OR `�