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p, Date SEP 2 6 lssi' 5_ Permit No.
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SUPE RTOO Fee $ �_--
j Ap n I er y ma e to e City of Cupertino for a permit to install plumbing
�9 pipes and/or fixtures listed on the reverse side hereof, and agrees to installsaid prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
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CONTRACfOA, AGENT
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Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO nn
❑ Sewer Connection Sanitary Permit No....�er�h�-------------
[i�Plumbing Final Plumbing Permit No..%Pf,,Sg-3.-..--......
11-21, Lot'No..-..Id! --------------
Owner or Tenant -..[
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fTract .............. . .._
Date Connected .......
Date Final ...............
(jPLUMBING INSPECTOR
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