NO PERMIT NUMBER /C'/ I � -��✓ NV"� ' LOT NO.
NO. STREF,T'
R PLUMBING PERMIT
I' CUPERTINO
Z
w.
y 0 24 1967 Sanitary No.
0 f
LL
0 a Date �® �� 19�� Permit No
3
Pee $
Cifl OF CU ff ly�
w LL
s O
� Application is hereby ma c to Ity of Cupertino for a permit to install plumbing .
`. w pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all oth laws qpplicable thereto.
LL Use of Premises
0 0
3 Ownerg ` Address
zo
�
z $y Address
J O CONTRACTOR, AGENT
3 w Phone—
WILLIAM D. �^, i'�`d'CH
State License Approved
a o
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES 11 UNITS FEES
Water Ileater I Isize
Water Closet ,�— Material
Bath'Tub To Curb
Shower To Prop. Line ✓
Lavatories .L To Existing
Kitchen ink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
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
Vac Breaker
Skimmer
Filter
Permit Fee 2d1J
Total Total Fee ��