100163 /J I v`� LOT NO.
NO. STREET
ClikNb � OR PLUMBING PERMIT
wCI hY F CUPERTINO
s rc 7 Sanitary Ido.
x 0 ?APR 1 1968 '
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o a Date((`�I �/ n r'Ip�pY ,n1n6— Permit No
3 4 P1 I�T b FSF �y�hfalk48�F tiff Y P Pee $ 8 g
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� A c t n her d of Cupertino for permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provis s of the Plumbing Code of the City of
a w Cupertino, and all other la s applicable ereto.
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Use Premises
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O NTRACTOR,AGENT
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f State License >\/S-3 Approve
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— PLUMBING INSPECTOR `//
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bach Tub To Curb
Shower To Prop. Line
Lavatories To Fxistin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash-T-ray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader StormDrain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee