NO PERMIT NUMBER<s
I LOT NO.
No. sTit fr.a'
II - 11 f.�
APP.LICATION,FOR PLUMBING PERMIT
G.ITY OF CUPF.RT[NO
(h 1967 I "// Sanitary No.
Date / l 1947 Permit No
—U�
n• -\r n- !s• :')G[), tee $,>� S
Application' -;k her&b'riadeito'I�e 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 iatvs applicable thereto.
Use of Premises
State License 1-i�rr.'S-2% -
re
Add
. j
Address
ApprovedL-/J<9 So--�-� 4
PLUMBING INSPECTOR
FIXTURES NUMBER ES �� MAIN DRAIN
UNITS FEUNITS I FEES
Water Closet 1 -2/ 1, 36D II Material G/. I ■
Shower I I� 11 To Prop. Line v -
Lavatories .,,D To Existin
Kitchen Sink 3V Not Conn.
Dish Washer Sewer Rax
Material
Comb.Sink & Tray I 1 11 To Curb
Fountain
WATER SY
Size
Material
TOT,
Fixture Fee
Main Drain I
Storm Drain
Valve