1461 (2) �C ` % N\\ C I Q 1 I " LOT NO.
NO. STREET
A 10 R PLUMBING PERMIT_ . .�
C CUPERTINO
MA-R 23 02
Date 195_ Permit No. �t-
CITY OF CUPERTINO Fee $�
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and fixtures listed on the reverse side hereof, and agrees to Install said prices
[[��0 and/or fixtures in accordance with the provisionsf1the Plumbing Code of the City of
•t� Cupertino, and all othe�lawsgpplicable th'eret� I
v Use of-F emises
:a
Owner - Address
B R _ Address rd�y
Approve.
PLUMBING INS C R
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1 " 1 Cupertino Sanitary
r = t i Office Copy
i BUILDING INSPE�COR'S OFFICE '
CITY OP CUPERTINO . r
❑ Sewer Connection Sanitary Permit No. ✓./�.._.-----.
Plumbing Final Plumbing Permit No. .... / ------
Lot No. ..................
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Owner or Tenant .. .. . . ... .... �....._
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Tract
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Date Connected ........................
... .��._'---'---......--_..----........_........ ......----.... 19..1ot
Date Final -------------------- ---.-.----------------
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