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APPLICATION OR PLUMBING PERMIT
wiITY , F CUPF.RTINO
2 4 196`5 e�
r o Sanitary No.
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30 J Date l Permit No.
3o L60 U CUPER'i r, Fee
Applicat n is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures-idaccordance with the provisions of the Plumbing Code of the City of
a w Cupertino,' nd all oth ws applicable hereto.
., Use of Premises __p
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o a Owner Address
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=CONTRA OR AGENT
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State LicenseJ! S ,�� 7 -_Approved
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V.t I PLUMBING INSPECTOR
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rinkler
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xture
RECORD OF INSPECTION
Bldg. Dept
1
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection
&-911;�bing Final
Owner or Tenant
At ----------- ZZ
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Tract ---------------
Date Connected -.
Date Final
111 7/63-1M
Sanitary Permit No.; ..
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Plumbing Permit No. -----------
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