51001.3 (2)l` sC��93 I &14 —:5�(Z--- — LOT NO. /
NO. STREET
ef�PLjFOR PLUMBING PERMIT
fi`1� OF CUPERTINO
MAY 23 1968 Sanitary No.
DateII ,n(196_ Permit No .S^/O O/, :1hsFieTPee $ 3. SO
t�'�lieYitio� (s hl �[R�Al�ite 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 in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner /A oS.Fi46MLfAddress
D xAddress
By -Y'
AGENT
Phone ?2—ySS�
Approved WILLIAM D. SENMC14
State License
PLUMBING INSPECTOR
FIXTURES I NUMBER II MAIN DRAIN
UNITS1 FEES 11 UNITS FEES
To ProD. Line
Dish Washer I I 11 Sewer Box I I
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
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee c�2. �
Total
Total Fee d�