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?,�f�PLI�-310N FOR PLUMBING PERMIT
IIOF CUPERTINO
/ I J Sanitary No, .S -) r9 3-
Date �6 1967 (962 Permit No
�/ nnr Pee$ �-C- 5 e,'
Apptl cati0. 11 %)R dre to�PhelCity 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.
Phone '3
State License.���G3 ��—
PLUMBING INSPECTOR (�
.1
FIXTURES I NUMBER MAIN DRAIN
UNITS I FEES 11 UNITS I FEES
Material
Lavatories .To Existin
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Size
Water Softener
Comb.Sink&Tray I 1 11 To Curb
Urinking t'ountann
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee sliv
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve I
Gas Fee
Permit Fee
Total Fee