973 LOT NO.
NO. STREET' �-
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APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Date_/ 4-C Permit No.
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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
" Cupertino, and all other laws applicable thereto.
Use of,Premises E .S ie�k-
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Bldg, Dept.
Offim Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
n Sewer Connection Sanitary Permit No.
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@RO'Plumbing Final Plumbing Permit No. -------9,-/�,?
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Owner or Tenant ---- -------- -------------- ----- ------
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At .. -------------------------------------------
Trac ............... -- - ------------------------------------- ---
Date Connected ------------- ------------/-. .✓✓_-.--........._._...--......-.. ....... -- 19- .
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Date
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Date Final ..................................
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PLUMBING INSPECTQR
111 7/61-500