2076Iu36,? LOT NO
NO. STREEI' /
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/'APPLICATION FOR PLUMBING PERMIT
z CIT4' OF CUPERTINO
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° ��fiAY� 9903 t
Sanitary No.
0LL X07(
0' Date / % 19fi 3 Permit No`_
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Qpplitation Is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
Z and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable, thereto.
0 w Use of Premises
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o e Owner Address �4,.>ti�
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o BY L r� Address
3 r CONTRACTOR, AGENT
— V Phone �5 3 7�
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w E 'tate License _Approve
PLUMBING INSPECTOR
H\
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection a Sanitary Permit No. ---- ......
[.41ttmbing Final Plumbing Permit No. . ......
Lot No.
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Owner or Te ant.
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Date Connected
0�-.: :74pe%-7 ............................... ......... . .... 19 ----A0
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Date Final me.
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111 7/61-500 PLUMBING INSPECTOR