1774 (2) LOT NO.�
NO. STREET i
-APPLICATION, FORjid;'�
PLUMBING, PERMIT
CITY OFERTINO 11'
Date �L 19k Permit
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A lication is hereb made to the Ci o ertino form ermit to install lumbin PP - Y tY• P PP g
pipes,and/or fixtures listed on the reverse hereof; and,'agrecs to install said prices
(� and/or fixtures in accordance with the piovisiiins of the Plumbing Code of the City of
r Cupertino, and all other laws applicable'thereto.
Use of Premises C
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Owner. Q Address 95
By r - Address
CONTRACTOR, AGENT �-`
Phone. — `•3 tf 7� _ Approved
"6• ` CUtiBING rNSPHCTOR
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., •:..,..,....-A Bldg, Dept.
,i• '^ Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Q
Sewer.Connection SanitaryPermit No. .-0M..7 .........
&*tluimbing Final Plumbing Permit No. ...l.. 7.........
**,Owner' or Tenant .... t
At /s"s ...................... ......... ............................................. .
Date Connected ........ .._ .:...•.....,..1.� .................................... .............:. 19..LO.Z
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Da
p, :......:. 19
PLUMBING INSPECTOR
7...' :. ••o G
�`' 111'7/61-300