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I ICAG,N� OR PLUMBING PERMIT "
J IAPB 17 1961 IOfi•CUPERTINO
Date
95_ - .. Permit No.
.uo� t. ' � 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
-'`and/or fixtures in accordance with the provisions of the Plumbing Code of;the City;,of
°j Cupertino, and all other laws applicable ther'et'o'
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P ruse of Premises A6t/ C41
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Address
'CONTRACTOR, AGENT tf <I
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v\ Phone Approve c s I
PLUMBING INSPECT
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► NOTICE OF ADDITIONAL -CHARGE
CITY OP-CUPERTINO
BUILDING INSPECTOR'S OPPICE
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Permit No. )To ...... � ... . ..... . . . - -- --
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Amount$ a1 Si ned _ - -
Io6 3/59-300
Cupertino�Samtary'
'.'Office Copy'
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BI�ILDIN 1
G NSPECTOR.rS OFFICE —
' CITY OF CUPERTINO'
Sewer Connection - :r•..'. .. . ..
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