51167.1-?z LOT I ��/.rYl/�G!sL1/SCJ ,.d./N - LOT NO.D
NO. 51REE1 JJ
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
w�
x oSanitary No.
R w SiiG. 7,/
o < Date �� 1962 Permit No
w. LL Pee $ 2, .SZJ
so
LL w , V'iI-plicaPio is hereby made to the City of Cupertino for a permit to install plumbing
o a Lpvs kan2 or �fi�tdi'c�liisted on the reverse side hereof, and agrees to install said prices
> and/or fixturesunlacfordim (e with the provisions of the Plumbing Code of the City of
a Cupertino, and all oth Ula' s applicable thereto.
17
Use of Premise' -
oro, y
>•,tT n
3 Own r Address_
z_j ,C r.,� /.�"3s� %7 7
z By Address
O CONTRACTOR,AGENT
3 �
— m Phone
w z LiA:q b. `: i_f•i:�di�iy
u Y State Licensee?9 Approved
a o
— U PLUMBING INSPECTOR t/
u
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES 11 UNITS I FEES
Water
Shower I / 1 11 To Pro D. Line I ✓I
Kitchen $inG
Dish Washer
Waste Dispo
Machine
Comb.Sin"Tra 190 Curb
Dental Unit '
Floor Drain WATER SYSTEM
Hopper Size
Area Drain Main llrain Fee �j ��
Water Leader Stolm Drain Fee /.s 7�
Water
Relief Valve
Total