1782 (2) C>?&-t).3(CI�LL!'�G �C/ LOT NO.'
NO. rSTREET
VAPPLICATION FOR PLUMBING PERMIT
ISEP �9gy LOF CUPERTINO �7Date /' _ 19P v Permit No. L UY
STTOF CUPERTINO Fee $ ,�Zl.dti�,
m 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
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Owner 4'C-6� Address --2
By I Address
CONTRACTOR, AGENT
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PLUMBING INSPE OR
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Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
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Sewer Connection . _ _Sanitary Permit No. ... /.(p
' 8 Plumbing Permit No. .
r' lumbin Final -
Lot No. . .. ....
Owner of Tenant .. ..:...
At
.......... _.......... .............
Tracta�
Date Connected --------------- -- ----------
DateFinal ................... ...................... .......................... 19.V.y
PLUMBING INSPECTOR
111 7/61-500