1358 LOT NO. v
NO. STREET
PAT R PLUMBING PERMI
OFF /CUPERTINO
PC 15 1969
Date Permit No.
CITY OF CUPERTINO 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.
u Use of Premises
:a
Owner w Address
o� By Address _
I /N CO CTO AGENT
Phone T
Approved
/� / h _ / 51O� PLUMBING INSPECTOR
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10
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C
Bldg, Dept,
Office Copy
r BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
0 Sewer Connection Sanitary Permit No. ... ] ....S
Plumbing Final Plumbing Permit No. --"-- -+
Lot .--
Owneror Tenant -- _ --._---... . . -- ._-- ---- --....-----......-- ...................
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Tract -----... - - -.. _. ...- -.. ....... .........----.....--------..._......
Date Connected .. .. ..------- .. ....... .................... ...... ..... ...... 194;10
Date Final ------.. ...
..... . ...... ..... --------------... --- ----------- --- ... 79.5P..'�-.-
---------- - ----- - ..-.._..:.............
PLUMBING INSPECTOR
111 7/6I-500 -