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NO. TREEi'
APPLICATION FOR PLUMBING PERMIT
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a 5- IITY OF CUPERTINO
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Sanitary No.
Date �fJIAR ?Q IORA �! 196_ Permit Noi�//?q
t I
Pee 9 A—
Akpplicationris tierebyl,nadelto,the City of Cupertino for a permit to install Plumbing
pipes and/or (ixture's 'oil tile) 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 other hirable thereto.
Use of Premises ,
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State License. Approved' &IJ-19��l
/
PLUMBING INSPECTOR ✓
FIXTURES I NUMBER II MAIN DRAIN
UNITS FEES 11 UNITS FEES
Shower
To Prop. Line
Lavatories
To Existin
Kitchen Sink
Not Conn.
Dish Washer
11 Sewer Box
DRAINAG
ze
_Comb.Sink R Tray To Curb
Dental Unit
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee d�
Vac Breaker
Skimmer
Filter
Permit Fee o2. 0-0
Total
'Total Fee 3 6-0