NO PERMIT NUMBER/0el70 I �CtLOT NO. /a0 -2o-/j
NO. STREET
3!"LrTT ON FOR PLUMBING PERMIT
® Y OP CUPERTINO
Sanitary No.—
Da
o.Dai (SE�/:� 1968,' , Permit No—
Fee $
o
Fee$ '3/,00
&11)fatiol'is I� ItQf,�e City of Cupertino for a permit to install plumbing
pipes and/or Ixtures Is ed on t 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 aper laws applicable thereto.
Use of Premises
Owneri), Af!gz-- /�� Q dlu � 70t7
CO NTRACTOR, AGENT
Phone -96 - a y
Addressx�" Cjn-�
State License 03" 3 f Approved WL -L1,: -!i - - --- ' --
`x PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
UNITS FEES 0 UNITS FEES
Water Heater
Size
Water Closet
Material
Bath 'rub
To Curb
Shower
To Prop. Line )<
Lavatories
To Existing
Kitchen $ink
Not Conn.
Dish Washer
Sewer Box
Waste Dispos
Comb.SinkB'1'ray I 1 11 To Curb
Floor Drain �� WATER SYSTEM
Hopper Size
AL FEES
Area DrainMain in Fee .0-0
Water Leader Storm Thain Fee
Sprinkler Valve I 1 11 Water Svs. Fee 1 /.0f0
Breaker
1'e[out Mee
Total Total Fee