1349 ro I LOT NO.
N6 STR�IIET.
APP ICA�TION FOR PLUMBING PERMIT
® 1moi l 1F CUPERTINO C 2 l y
Date GGGGA'0�'0������
^ 4nnk _ Permit No.
Fee $
Apya �n i�fre9Tt ®ty 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 ap�\t\6t)�.thereto. / n
Use of Premises_ C —�1-"�1�.7C�Y 1/V�.�.-+SZ_ .
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OwnerAddress Lo 1�
By Address
ONTRACTOR, AGENT
' hone Z L Approv
1 PLUMBING I SP CTOR
UC � � �n° oH' n�E C
a O w n a w w N o w
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via
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I, the undersigned do nereiny -C,—Aify that I am
the owner and o .h cup,�nt of single family dwelling at
Oc,� v or which I am making
application to do ork as a home owner.
isc certify that I will not hire any non-licensed
r contractor, but will do this work myself.i LMIHONE 14,11 S SIO^:ATURE
Cupertino Sanitary
+ Offze Copy
BUILDING INSPECTOR'S OFPI E
CITY OF CUPERTINO
F1 Sewer Connection Sanitary Permit No. '. / � ----------.
o Plumbing Final Plumbing Permit No. ..,1.3 ./
........ ...... Lot No. ------------...........----
Owner or Tenant ...../ 2 y .:.. - - ------------------
At
---- .......
Tract ..... Ci....��i'!GYfT �,,e
. . ......... ..........._.......__.. ._..._._.__-- ..... ................. ----------------.......
Date Connecte �-------------------------/��/P. _.............- - _ 1J��..
Date Final --------------------------------- 1)- -
........................................ ...................
1 1 1 1/60-500
/PLUMBING INSPECTOR
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