1267 LOT NO.
ANO. STREET
1 l� ION FOR PLUMBING PERMIT
D�
IUI CITY OF CUPERTINO •
X11 SEP 2 6 19F
Date SFF 1 V �q�i� , 195_ Permit No.
CITY OF CUPERTINO Fee $ A 102
,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 otheraaws applicable thereto.
Use of Premises
Owner(e/PLCY rYD14V"C S Addres "INSPkT
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Cupertino S.nitary
,Off:p^Copy
-
BUILDING INSPECTOR'S OFFICE'
t - CITY OF-CUPERTINO '
Sewer Connection 8. .
- - ❑ Sanitary Permit No. 4�8.7..............
ML:.•Plumbing Final - Plumbing Permit No. F 1.. ..-.....
Owner or Tenant-.....i ii.i!/ .L!Ge7 �J . ..... ........
Lot Nu.'�....•--
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.Tract --------- J, i�!Y.v�uC•G c------.q..:._......-..........:....... ....?.-....._.-:.........._.._.
Date Connected ---- ---- .... .... -
Date-Final .....l �T..
,PLIJNUING lNSPECTOR `