HomeMy WebLinkAboutNO PERMIT NUMBER a 1` 7 l IJ `Y LOT NO.
No. STREET'
APPLICATIOJ�� $ING PERMIT
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x o Sal itYry� No.
nate 3 0 YKEP1969M 1968 �PLLJ t No.
3� Pee $ o�a �
° Application is hereby ma'ite"(6 t{2 dy'E'7Cp �ar'o' r a permit to install plumbing
o � pipes and/or fixtures hste'dton'the reverse side hereof,�nd arees to install sid pric s
> < and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a(Jr) Cupertino, and all other laws applicable thereto.
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Use of Pr 'ses
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Address �y 1��� x2
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O CONTRACTOR, AGENT
3 93-Fs0�7
— `m Phone
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OY State License �•'?R93� Approved
a U X PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS PEES UNITS FEES
Water Ileater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray o STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.SinkRTray T Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain 0 0
Water Leader Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee QO
'Total Total F,,;40k —