825 (2) LOT NO. _
NO. STREET
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• APPLICAT ' Aft FOR PLUMBING PERMIT y ,--- •
"J, CITY OF.- ERTINO
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J Date x 1 A. <'
_ � v Sx-� Permit, No.
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Fee $
'j Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixturesllisted on the reverse side hereof, and agrees to install said prices
r 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 /- `.4
a
Owner • T / /,7 Address.s
gy 5 ///� Y
Address /f.7,?c .'0,•„pr/7. � T
CONTRACTOR, AGENT .f
Phone Approved .
\ /PLUMBING INSPECTOR
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RSff Cupertino Sanitary
Office Copy
BUIL"DINCw'I 'S OFFICE
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a1, •IY�. S itary Permit Ido: .:. ...%..........
•'• Plums + "+etcyy''
�;:�Y �� � ♦ Ar�Y Iwnging'Permit•No. .:-��s::�,..---...,..
•. ,.�.. '��' a Lot Nm..,........................
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Owner or a
1§ar[ '............._....::..,..:................-----......
Date Connected
DateFinal ........................... ......... y -.......... ......----- 19
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PLUMBING INSPECTOR
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