766 / a -)J t2 -O � LOT NO. 1O 3
/7 NO. STRP.P.T
P,PLICA ION^FOR PLUMBING PERMIT
14VOF CUPERTINO
Date
rou N 2 199 19y10 Permit No.
CITY OF CUPERTINO Fee $ i�
N 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 apppllicable thereto
Use of Premises_ 1�.�/LGLIAGa//�
OwnerAddress 64 / ' (e
7
331nn_rn fIG�Illilhi,fiaT�n�_ Address
CONTRACTOR, AGENT
Phone Approve
II PLUMBING INSPECTOR 010
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Cupertino Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO p�`/
�Sewcr Connection Sanitary Permit No. .I-(@4/ 4 ..
F-1PlumbingFinal Plumbing Pcrmib No. ._..[.-4y.4
Lot No. ..._---
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Owner or Tenant ...------ ---... ^-A-t9-4-`�-� - --- -------........
..........
'- ----
Tract ---------------------- -- .
Date Connected -----------.----.-...._.--- _
Date Final -----------f..- .'._�
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PLUMBING INSPRCCOR
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