51167LOT NO.�Ad
NO. STREET
�_ PPLICATION FOR PLUMBING PERMIT
C`TY OF CUPERTINO
x 0 Sanitary INo.
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0' Date / - 2 1907 Permit No
a �+ �/ (� pCpy' (�
3 LL QST i fo'r�. ���g 4S�d�Fd� Pee $
To
pp tat n Is her y the City of Cupertino for a permit to Install plumbing
`o < 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
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Cupertino, and all other laws applicable thereto.
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Use of Premises
Owner��
By
CONTRACTOR,AGENT
Phone 2J-3, Z 9 7 8
State Licsl��
Address &13/ 6WWi' t
Approved
PLUMBING INSPECTOR 1*01
FIXTURES NUMBER -MAIN DRAIN
UNITS I FEES 11 UNITS I FEES
Closet
To ProD. Line
Dish Washer I 1 11 Sewer Box I I
Size
Material
Comb.Sink & Tray I I I To Curb
Floor Drain I 1 11 WATER SYSTEM
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
_
Filvz
Permit Fee Oil
Total
Total Fee