124 e rz Fz t r i � LOT NO. /
NO. STREET .
D A01
R PLUMBING PERMIV
CI CUPERTINO
MAY 261961Date J5 � 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.
8 Use of Premises—Z
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CONTRACTOR, AGENT (/
1Phone['/ ^ 3 4- _ Approv`
PLUMBING INSPECTO
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Cupertino Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No ----
B"Plumbing Final Plumbing Permit No.
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DateConnected ----------------------- ------- -.07......... ... . ... .. ......... .. ........... 19.41-
DateFinal ----------------------------------- . .0.....----......----------..--------------------- 191W
UMBING INSPECTOR
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