10405 E
®1 JAN 23PklFT FOR PLUMBING PERMIT � .
�dbb�� OF CUPERTINO
DataVl. •ry 6x-f31PERTINO 1962 Permit No. 0'IU
M, Fee $ X�^ ;2,,<
\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 applicable thereto.
Use of Premises -
:4
2 D y}
41 Owne� U *� Address
By� 6 Address 2 4'16�koff-o.;airy
CONTRACTOR,
] AGENT _
�; Phone U — 3 �{Approved PLUMBING INSPECTOR
Cupertino Sanitary
Office Copy
Al BUILDING INSPECTOR'S OFFICE
CITY OFF CUPERTINO
F1 Sewer Connection Sanitary Permit No...../7 2'2F ---------
[VP]umbing Final Plumbing Permit No. �/b ..........
of No...... // ................
Owner or Tenant .... ..
........................
At ......
.............. ----- -------- ----------
Tract ..............
. ...... ..... ..... .... - ...... -------------- ................ ....... .............. ---------- — ........
Date Connected ----- & ------------ ---------- 4�/Yo 19W//--
Date Final ---------------------------------------
- - ------ -- * . . ...........................
Iti 1/60-500 5�PLUMBING INSPECTOR