864 (2)� ..y'������ ITr • n a LOT NO. .-...—
NO. STREET " • " '
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APPLICATION FOR •PLBING PERMITS .•aa.
} CITY OF CUPE INO
Date 196 195_ Permit No. � /
l 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
v
Owner Address
By AMARAI DIIIMRI_ l,�I ., _ Address
Phone $ANTA CLARA CALIFORNIA Approved /- I "L
PLUMBING INSPECTOR
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Cupertino Sanitary
% Office Copy
BUILDI~G INSPECTOR'S OFFICE
CITY OF CUPFRTINO
F1Sewer Connection Sanitary Permit No: _..._1..k7. S!.............
Plumbing Final, :'- ryry
.............g:Permit No. 0.......
. . Lot No. .,,/37.......
Owner or Tenant .._.. ....rt�F .....V/ '.D�CJ..:.Q%f�,�,.G.,.._. ..._C. .. ... ...'::.-
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Tract
jam... .. .........._...:.....----------....................... ........
DateDate
Connected ............=----------------- -u+ / ------_...----------------_.._..... ......_ 19./x'
Date Final _-..._.�.a _.......-- --............... .................._ 1950---
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.UMB NNG'INSPECTOR
� llt 1/60-500 � � I