2069l0 LOT NO.
Ncc L,�\ST EEVrl
EMAY
��APPLICATION FOR PLUMBING PERMIT
w z 161963 CeITY.OF CLIPPRTINO
x o Sanitary No.
RLL zz 6 9
o J Dat ----•-•d961 Permit No 0
I i U7 LuPER I u:t��a Pee g o0
W
�o
Application is hereby made to the City of Cupertino for a permit to install plumbing
o` a 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
a W Cupertino, and all other laws applicable thereto.
Wx
a
J
O 0 O
>m
r3
iJ
J Z
J p
3 F
a
N
W Z
W W
rc a
U' E
Use of Premises
Address -3&-- �' A I" '"'�``,'"`'�
Address /'3�1 /5�
License v ! _ Approved
PLUMBING INSPECTOR
MWater Heater
ater
rea
kler Vnivcs
rain
Sewer Boxes
hu
RECORD OF INSPECTION
FEES