2536'&"" I / / //�.//�C_!iC -_ C L LOT No.� _
NO. ATREET
A�PPLICATION;FOR PLUMBING PERMIT
CITY OF CUPERTINO
�'=C 19 ,t,:! _�?�
Date 19,' Permit No. -,?6
�'.
1Y OF Cu.- _ Fees vo
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 —1-1 1L"U-�—
Owner // t/ Address An 4 0/1
ByL/_ i �/ . .O� Address
2
Phone cexr Approved
tzPLUMBING INSPEC4OR
'x1
Ell "IMUM
! ifice Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPGRTINO
❑ Sewer Connection Sanitary Permit No...~�..,f...-_.
j� plumbing Final Plumbing Permit No...{�196 ...`..
of No... /
Owner or Tenant ._.�-.-.._ ..Gn". AG ....
At�,r. � � .. -- ....... ..... ..............
Tract -----------
Date Connected
Date Final --------------------- ------ .......: n�. —
-- 19 ------------
-TOR