1791 LOT NO. .
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LAPP a AT CN FOR PLUMBING PERMIT
'1 SEP 17 'Q6a �� OF CUPERTINO
Date , 19-5 6 D Permit No. t——lJ—
CITY 0 , CUPERTIMO Fee $ •�A '
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 Premises
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CONTRACTOR, AGENT SIM
Phone �i /A �/ S 3 Approved
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Office Copy
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BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO //
❑ Sewer Connection Sanitary Permit No. ......Zp Z? p
umbing Final Plumbing Permit No. ..,/. •�..jf
-....
Lot N ... _. .. -.......
Owner or Tenant
At . _ _
Tract _. . ._ ._._._�..'_......._...._..._.....
Date Connected _........................... .....---0 19
. .............. ......- --------------- __
Final ........... ............ - __--------------...-- 19... .`�.
. ....... .. ._. .. .- --....
PLUMBING INSPECTOR
Ill 7/61-5oo