1534 (2) /ALS/ I / � � O'a, LOT NO.
NO. STREET
LOP„LICATI . FOR PLUMBING PERMIT •
® 2 QI�}YI:OF CUPERTINO
Y8
196 Q-
,IMA 3 .
Date 195— Permit No.
ERSINO ,�
� CITY OF CIDP Fee a-/
App icatlon is hereby made to the City of Cupertino for a permit to install plumbing
(J 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 otherlaws applicable thereto.
Pr' Use of Premises
Owner // N' Address
By� _ Address, CONTRA�OR, AGENT
�J Phone_%7l 7, �fL ZApproved
PLUMBING INSPECTOR
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i
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO nn//
[] Sewer Connection Sanitary Permit No. .....
d(G?,�.. _......._
[a/Plumbing Final Plumbing Permit No.
/ Lot No:. .._..-....._._..
Owner or Tenant .... .�.. ..,J.!. .
Tract ............. ���
Date Connected ... .......- -------------�Y -----...-............... 19.��
Date Final - -- -- - -- _........ - ... - ------ -----
..._ -------------
Ill 7/61-500 --.....
PLUMBING INSPECTOR