51167��I�JLIL�I/� y�t• LOT NO.
NO. STREET
® OR PLUMBING PERMIT
C 3u CUPERTINO
F 27 1968 Sanitary No.
Date (IT��/ (a�[/ p pT ,nI196Z Permit No
fpit- 6 Q q'r111�d)NQ 7 P Pee i a� g
A � i -. ti n sere a d � of Cupertino for permit to install Iwnbm
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-
�/
OwnerAddress
Address
CONTRACTOR, AGGNT
State License1/0&-f /—
Approved / ✓�✓ _
lL
'\ PLUMBING INSPECTOR
FIXTURES I NUMBER 11 MAIN DRAIN
UNITS I FEES 11 UNITSTES
Water Closet 1 �3 11 Material Il/ I
Shower : I i 1 11 To Proa. Line I ✓ I
Not Conn.
Sewer Box
STORM
ze
Comb.Sink&Tray I 1 11 To Curb
Urinkin Fountain
Floor Drain WATER SYSTEM
ze
ee
Area Drain I I k Main Drain Fee 13—
Filter
Total Fee
I Hee
Fee