1772�l Iy LOT NO.
NO. STREET
APPLICATIO OR PLUMBING PERMIT, •
CITY OF CUPERTINO
Date Permit •Noy '
M Fee $ ��' OC)
�n 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
t and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
�Yyav Cupertino, and all other laws applicable thereto. '
Use of Premises --4 ''•— '
v
�4 Owner Address ^
-Address • n ' 'L!/
CONTRACTOR, AGENT 1:+. ••
' PhoneUH� �9 y 9 % kApprove
4 ,fir
0
3
Bldg. Dept.
Office Copy
AUILDING INSPECTOR'S OFFICE
I CITY OF F CUPERTINO
0 Sewec.Connection Sanitary Permit No. /.. ...........
.. •.,+, y
. ' a�'PIUTbing.FiriaL,,, •. • Plumbing Permit No. ..........
Lo No. J
.............
: •Ovine : br Tenant .-... -
,r --
�.
44
......
....
at¢.Cnnnbct (i .LL•�O ,•!.�....� ..:................................
......
,
...._ _
s.,.
II/ PLUMBING INSPECTOR
111 7/61-500 j'