1773 I.. . : �!,'`^•' . LOT NO.
NO. STREET .
APPLICATION FOR PLUMBING PERMIT
p CITY OFF CUPERTI 6
Date fI' t pr Permit rNo:
Fee $
I (� Application is hereby made to the City of Cupertino for a permit to install plumbing
I Q� pipes and/or'fixtures listed on the ieverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
tCupertino, and all other laws applicable thereto.
Use of Premises-� -
4 h Owner AddresslX &— Y"+e
By4&mr:�C -rj�4z- Address
4 .J CONTRACTOR, AGENT
Phope_lljy 7— r!7 7 Approved
PLUMBING INsPVCTOR
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Bldg.-DBpt.
' - •+1-;? Office Copy
BUILDING INSPECTOR'S OFFICE '
CITY OF CUPERTINO
a
r ❑ Sewer Connection Sanitary Permit No. . :�1..4.: ............
vEf Plumbing Final Plumbing Permit No. .........
LotLot
No.11.11.4�................
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Owner or Tenant ..... ................ .........6� %(�!'.-
�— _ •
Tract
Date Connected ..... ....:.....:...... .:�7:.............................................._...........,....,....-.-.... :.
.
Date Final
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` PLUMBING EVSPECTOli
y ,
111 7/61-500