NO PERMIT NUMBERa a 3 --.21 A CLAL.t"i '0� . LOT NO. 949
NO. STREET
/ P.P.LIC BION FOR PLUMBING PERMIT
OF CUPERTINO
f o � � Sanitary No, r0 7f
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o Date f 4FP ✓ 196 Permit No
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w a Fees 2.9
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° Appiication istdrerz N T�'tt44ie City of Cupertino for a permit to install plumbing
`o a pipes'and%0'r ft�ctures lti�+llidVicberse 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.
a Use of Premises / /�a-c-✓y-- /�f/� %y////1 ///J/J
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Address
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° CONTRACTOR, AGENT
3 a ci3—�O 7 7
- m Phone
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a o State License. Approved "VI
U PLUMBING INSPECTOR /
1 V
FIXTURES 1 NUMBER 11 MAIN DRAIN
UNITSI FEES _ UNITS I FEES
Material
Shower
Not Conn.
Sewer Box
Wash
Size
Water
Comb.Sink&Tray I 1 11 To Curb
Fountain
■ Skimmer
WATER
Size
TOTAL
Main Drain Fee
Storm Drain Fee
Water Sys. Fee
Cas Fee
Permit Fee
Total Fee