947 (2) LOT NO.
NO. STREET
V` ON FOR PLUMBING PERMIT
flo�Te95 tCITY OF CUPERTINO Q Date g` � 19" Permit No.
CITY OF CUPERTINO Fee $ 1'1' ,2r
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 thelCity of
Cupertino, and all other laws applicable thereto.
Use of Premises /7 C,""
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2 Owner—/ Address
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C CONTRACTOR, AGENT
e_.yb Phone `M7- -i Approved
LUT ING INSPECTOR
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Cupertino Sanitary
1.Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO Jj
❑ Sewer Connection Sanitary Permit No. .....�..7�./ 1......._.
[P' Plumbing Final Plumbing Permit No- ------9hV 7.._......
LotNo. ...... ----------------
Owner
--Owner or Tenant ...... ✓N..L!e��lfi�........L.v.G ........
- ... .
III Tract ..... .. lo
.-'.... . --
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. . . ------ -- 19-6 .Date Connect
DateFinal ..................-----........ .c-. . .. --- ...-------------
19/1...
....--"... Q........_. .....................
INSPECTOR
Ill 1/60-500 (%