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ONFOR PLUMBING
w z t CITY OF CUPERTINO
APR 15 1965
r o �- Sanitary N(
Q LL
PERMIT
,5-- r" S -j
Date 1962 Permit No
� ! Lli- 1, ,-L-UINOS°
Pee $ �P3•
Application is hereby made to the 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 /Z7 2)
Owne 6 - (/lWi� P Address-�+�-?�- ��eL'tai
By 2 �./`�- 11 C Address
CONTRACT9K,AGENT
PhonePa OU
State License-3��--�
PLUMBING INSPECTOR �/
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS F
1 II Material
Shower
/' `'
'IbPro . Line
Lavatories
3 `'
'Co Existin
Kitchen Sink
/•3`
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/. 5
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYS'T'EM
Hopper
Size / sa
Restaurant Sink
Material �od
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee .5-f0
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee Sz'
Vac Breaker
Skimmer
Permit Fee
Total Fee