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'A P �ATX;"I,,FOR PLUMBING PERMIT
C* b% OF CUPPRTINO
(Jl 2 1963 �Y11 Sanitary No.
Date ITS/ /�I'n pYS 196 Permit No ZoZ/
CITY `, R Y N Cee $
Application is here y ma e to the -City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed nn the reverse side hereof, and agrees to install said prices
and/or fixtures in accordancewiththe provisions of the Plumbing Code of the City of
Cupertino, and all other laws applica a thereto.
Use of Premises �^
By zxwd n.Q ^ ti P . ^^� Address 3 3 90
Ay
Phone _% Y L — 3 i 6 3
State License ! -Approved
1 PLUMBIN�GINSPBCCTTOO'
UNITS I FEES
uisn wasners I A10lili. 0 G II Sewer Boxes I
OF
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n Drain
Fee
a
Bldg. Dept
Office Copy
BUILDING INSPECTOR'S. OFFICE
CITY OF CUPERTINO
❑�Se` Connection
Plumbing Final
Owner or Tenant .................
At... .............
.....................
Sanitary Permit No.5�-j -----------
Plumbing Permit NdZZ3L&..Q ..........
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