2030I9//Y�/•SLI✓ /G�/U.V/ /I.NV, LOT NO. /6q
�0 STREET
`NPnAPyPLICATION FOR PLUMBING PERMIT
r CITY OFF CUPERTINO
1 Date, .`.r Z l; _ `.. - ; 19(2: Permit No. O O
' Fee
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
Gand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use ofPremises i' -A I—A
Owner' t 1. s v �S(= %1 l..Q Address I . 7) Lf= I �-
y !X71 i c -c?— ala ]cS _ Address 1ED
CONTRACTOR, AGENT CAM) n
INSPECTOR
No
B14. Dept.
Office Copy
BUILDING INSPECTOR'S_) OFFICE
CITY OF vn=
U/S�mff Connection 4 :Sanitary Permit No.........
0 Plumbing Final Plumbing Permit No !a!P .........
tot No . .......
0,2 Owner or Tenant .... . ......... ... . ... ..... Z
At ............ t
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Tract .............
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Date Connected .............................
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Date Final ........................ ...
PLUMBING INSPIlf-7.011,
111 7/61-500