NO PERMIT NUMBER (3) c No. Street Lot No.
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LUMBING PERMIT
E ®,SEP 5 CITYPERTINO
1968
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Sanitary No. _� 7J/7
Y Date CITY
_p�ja('� S?1� O Permit No.
3 lII I Uf lrUrC1�1 '1V Fee S
r Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'c laws applicable thereto
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m A Use of Premises
' ° Owner Address r2
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By Addressfir' 4i /Q
3 Contractor,Agent J
° Phone„� ,79_2 6:'•715�
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3
— -� State License w< Z G / S. S G Approved
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste , osal
Wash Tra STORM DRAINAGE
Washing 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 MateriInF
Sand TrapTES
Urinal Fixtur
Area Drain Main D 00
Water Leader Storm Sprinkler System Water
Relief Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fec 00
Total Total Fee