1086 (2) 1Dy �o _ S
LOT NO, l7
NO. ST
FOR PLUMBING PERMIT •
Yti'R 4 1�`y OF CUPERTINO
Date 3 1SdY Permit No.
CUPERT Fee $
CITY, OF. 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_
y Owner 2 Address
By r . AW
Address
CONTRACTOR, AGENT
co Phone//41 7� _ Approve
/ PLUDIEING INSP TO
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Cupertino Sanitary.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO //ryry// ryry
❑ Sewer Connection Sanitary Permit No. ...,1[i..fPryrySF..............
[Plumbing Final Plumbing Permit No. .��lF.r...........
'In of No. ........" ...............
Owner or Tenant .... - : ...!4!. ... .. ... . .. .. ........... .....-�..------....._..
At .._1....Q� O...------ .moo..�u�l--2t.........................._..................
Tract ............. . . .. ................. .............---.............................................................
DateConnected ..... . .........................../ ............................... ........................
DateFinal ....................................../ ........... ......................................
............ . .... ...............................
._.'
iP bfBING INSPECTOR
111 1/60-500