1968 (2) LOT NO. �T
N PP
STREET
ION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
w z
x FEB 2 8 ?Q59 � Sanitary No. p
a s Date — g y 19�i3 Permit No d
3 CITY. C. rIIQRIrI� Pee $
Application is hereby' mad tot e.Gty of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed omthe reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
~ Use of Premises
J 0
3 Owner49=e=- E2 Addres":�J-*�'��
Z
�ry ' J z., l" Addres �Y GG
h °
P CONTRACTOR,AGENT
— <0 Phone C/'/V 7 eY 7
ww
a o State Licensc Al 21/3 Approved a
—U
l PLUMBING INSPECTOR
M 7^
; R =am
§ ' \ §
/
gym §
2a0 0 ° P ,
0t - � o2 ° wE
Zgm7E = lo \ »b
of
rm ITI
\
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
ry Permit Sewer Connection Sancta //
❑ t No. .....��fP�..
/��
�
Plumbing Final Plumbing Permit 'No. ....... .. .............
L t No. _ c/
s cr
i "Owner or Tenant
.......Ca ... .....---
......
....
......
F..:
. Tract - -
.... - --- . . -. - -:...............--. :.
Date"Connected., e s•.^f t'., s r���J ['1:Ill ;......
Date Final
,. •Pft: ------------------
PLUMBING INSPECTOR
111_-7/617500 _ i ,