51107.1 /O / (J '/) ILOTNO.
NO. ST EEI'
APPL•IGATII,O, N FOR PLUMBING PERMIT
d Citi Y OF CUPERTINO
Y o I' II' 1) Sanitary No -sGJ p Z--
a Dat• 196— Permit No
3 Fee $ .355 v
4 0 ftUY�ljYata;is ! _}Ey �i� Che City of Cupertino for a permit to install plumbing
0
pi a88d/bE fixtur bs on Be 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.
,. Use of Premises
00
' " ,7 _52PA4 A40� 109C)O ,✓fR 14,
o0 3 Owner, /J/ Address e��� / ,
z By � US A Cc /Y!/�e' Address �G C //!c ���^1VC1�
O CONTRACTOR, AGENT
3 < 9.
- m Phone � J L-
r9i "�/ Sy S� 7�'-"`"� 1/p
u s State License S 7 B Approve
a o
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FF.FS UNITS FEES
Water Heater Size _
Water Closet Material Cv/.
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existin
Kitchen Sink "NotConn.Dish Washer:WasteDisposal
Wash Tra INAGE
Washin Machine Water$oftener Bar Sink ---
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WA'T'ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee o2.S.
Area Drain Main Thain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee J
Vac Breaker
Skimmer
Filter
Permit Fee
Total / 02 S s" Total Fee