NO PERMIT NUMBERw r wQ
z z
W Q
f o
Y W
O J
W
NO. STREET
7AM %A r TION
�•L.� CITY
ItrOUL G 1967
LOT No. 3
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
ate , 196_ Permit N
w Pee $
_°CITY„ U oCUPaTto the City of Cupertino for a permit to install plumbing
o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
w =
r r
� . Use of Premises z'tr-a�1
go
"
0 3 Owner t- / _ Address
7
o a /.
J z By (/'�>+��. �.Y'✓C �.-�� Address /7 •'yam C�
J O CONTAACTOR�AGENT
f/
3 Phone -
0S % % �f �J7
w z !
a State License. `31 l� ty c) Approved
ao /
,1 — U PLUMBING INSPECT v
FIXTURES NUMBER MAIN DRAIN
UNITS FEES 11 1 UNITS I FEES
Shower
u
_ c70 I To Prop. Line
Lavatories
4 0-0 1 To Existing
Kitchen Sink
L
aO Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
v
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size '
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee O.O
Area Drain
I MainDrain Fee p'D
Water Leader
Stonn Drain Fee
Sprinkler Valve
Water Sys. Fee '"7J
Relief Valve
Gas Fee 1'.50
Vac Breaker
Skimmer
Filter
Vermrt 1,e
Total Fee