891 1 fYVO &J't.I - 4 , LOT NO.
NO. �-- STREET
�H ,-�APPL CA. flTION FOR PLUMBING PERMIT
t 6i CITY OF CUPERTINO
( AUG 2
DateZ 19j_ Permit No.
CITY 04- C ?ER INO Fee Zy Qa-
N Application is hereby made to the City of Cupertino for a permit to install plumbing
ly 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
v
Owner, /P C S(�L1 Address
By02 Ag TZ—Ad _ Address /
CONTRACT AGENT
Phone 3 963 — APPS
PLUMB[ 1 S7111'R
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Cupertino Sanitary
- Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No- ----L..�... ....
Plumbing Final Plumbiml, Permit No. ......(,j_/_
-__ ___
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Lot No. ` - ......_._...
Owner or Tenant ..� L..��4''`�1�..� ,�� -_... .. __...........
At ----.. .9lvo...-_fir- _ ... ....... ...... %.. .........
Tract
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Date Connected ................... o�2
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--- 19�,y.�.
DateFinal ...._ /7---_......- ................_...----..._....._.. 19.`. .�-
Pf:UDIfiI,\ INSPGCfOR
ILI 7/60-500 (/