51220.1'-2) 3 • ` I KK2—I C ' / ��� wLOT NO. 1I
No. STREET K.F. bev)sa �
�p"� 1 N FOR PLUMBINGVVV PERMIT
/.,:4 1 OP CUPERTINO /
® rid® Sanitary No.
Date , 70 , Permit No
. Pee S z9. fJ
Ap n (9�crc� �� �`��ity of Cupertino for a'Permit to install plumbing
pipes )rr (iSlt resW, d i he 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 laws ap )licable thereto.
Use of Premises/�Ps•rQ —�
Owner ,/�O/ffat� �r�i/ Address �/fil� t a0�
By 4;40L.�i Address
CON ACTOR, AGENT
Phone e?;;?—.>S%Y 7_19 /1
State License /� 65Z— `` Approved
`,{\
PLUMBING INSPECTOR
FIXTURES I NUMBER II MAIN DRAIN
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit m
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size '1
Restaurant Sink
Material Ge
Sand Trap
TOTAL FEES
Urinal
Fixture Fee i
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
11 Water Sys. Fee
Total