1778 (2) LOT NO. �
NO. ` STR�EET �'
fA PLICA ION FOR PLUMBING PERMIT
,CITY OF CUPERTINO
AUG 30
52
Date CJ 19�L Permit No. 17 77
CITY OF CRERTINO Fee $ i?, oa
(n Application is hereby made to the City of Cupertino for a permit to install plumbing
CI pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
�n 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 Premisesc �
h Owner Address gy�/l A()
_ Address
CONTRACTOR, AGENT J' --/f�
Phone�� ) `— cK _ Approved �f�i�
PL NBING INSPECTOR
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BUILDING INSPECTOR'S OFFICE
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CITY OF CUPERTINO
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Sewer Connection Sanitary Permit No. —1402.7?
Plumbing Final - Plumbing Permit No. .../L_/..Y...........
Owner or �......---- of No. .......... .._...............Tenant ... " . .. .. .. �•1
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Tract -•
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Date Connected ... ...... - �Q -
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PLUMBING INSPECTOR
111 7/61-500