1026 Cl Vn ." vi LOT NO.
NO. STREET
27,APP{L'f,�a CON FOR PLUMBING PERMIT
AM
OF CUPERTINO
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loot iftL19$1Permit No. f
r (' nn�� �;tJPp n'd Fee $
^ Ch�p lica�ion is hereby ma e 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 Ci tyof
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner( Ci��wo �� ( �f P���y Address
Address 'v4 lye u YGIi+
CONTRACTOR, AGENT U
Phone✓/V 7— ct`7T Approved
PLUMBING INSPE[TO
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Cupertino Sanitary
Offi.J'Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
M Sewer Connection Sanitary Permit No. ......177�........
[q'Plumbing Final Plumbing Permit No. -14a2ia
. ..................
Lot No. ------
Owner or Tenant ---
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At ------
Tract ...............
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Date Connected ------ ---------- - -- --- ----------I*----
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Date Final
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111 1160-500 6�111LUNIBING INSPECTOR