NO PERMIT NUMBER (3) 9/— V/I Y_u//fAJl9'!/� D�� LOT NO. /?
NO. STREET
�E1$PL ON FOR PLUMBING PERMIT
d iCUPERTINO
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Yo Sanitary No.
zJUL 6
o a Uat 1967 196_ Permit No
3 4 Fee S�1d
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(F to City of Cupertino for a permit to install plumbing
o w pipes and/or fixtures liste on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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a Use of Premises
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3 Owner �/ri-�t�U/�,r�-� ^//
Address
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z By lr..re!^.. ��i. Address ?-
O ']CONTRA/C�TO AGENT
3 a S L !Ute%�' _ LL�c..�-
- Phone
K4 1
a o State License. -� 5 n Approved
U PLUMBING INSPECTOR (/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater — Size
Water Closet 49 Material Z
Bath Tub °=° To Curb
Shower — To Prop. Line
Lavatories 6� To Existing
Kitchen Sink )i -' Not Conn.
Dish Washef Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit '
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size �'
Restaurant Sink Material
Sand Trap TO'T'AL FEES
Urinal Fixture Fee . 0-0
Area Drain Main Drain Fee p�
Water Leader i Storm Drain Fee
_$ rinkler Valve Rater Sys.Fee .J�
Relief Valve Gas Fee , �tJ
Vac Breaker
Skimmer
Filter
Permit Fee O0
Total Q, Total Fee Q D�