2033 LOT NO.
NO. STREET
I` APPLICATION FOR PLUMBING 'PERMIT
1 -.'�` CITY OF CUPERTINO
]:)are,, �;o�� -'x`''C/ "3,;195— Permit No: C�O �-
v� Fee $ 'J, • c7<�
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
61 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 �A•� - 7.
Owner VwS,SEA Q Address
By Lc:)(L::)cam— c10 K.Z;l ddlb&_ Address2 IAC"i
CONTRACTOR, AGENT
Phone C [ /O �O'C� Approve / -�
LAMBING INSPECTOR
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BUIL_ DING INSPECTOR'S OFFICE
"CITY•OF CUPERTINO
SewerC nech Sanitary Permit No. ...
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umbing Permit No. ........:.. .
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Owner or Tenant
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Date Connected ............. .......... "S �1
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Date Final 8 r 'it
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PLUMBING INSPECFpR'
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111 7/61-500 �1
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