51175i0 l0 9 /��"� �P� 02
LOT NO.
NO. STREET
AP, %—ICATION�F�OR PLUMBING PERMIT
�"--6TY(O't CUPERTINO
IS EP 15 1967 SanitaryN,I.
Date 9b— Permit No S-1 / '7 <
n/� IR
pD�1 pp pee $ 3 �7 e�
Appl ct atmn isU byrbjt7itl� pl , 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 /1�
Owner
��?.�Li/l.tl/ DCA44eBy Qwvf(/
CONTRACDAR,AGENT
Phone -31!
State License 2 3,0 4/0 -7
Address /10687-112/14F/ . n Ale
Address :a 2 -
Approved Approved
"r
PLUMBING INSPECTOR
1
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater Z 1 11 Size
Water Closet Material z
Bath Tub To Curb
Shower Y To Prop. Line//
Kitchen $ink y Not Conn.
Dish Washer Sewer Box
Com
b.Sink&Tray To Curb
De❑tnl Unit
Drain
Size
Urinal Fixture Fee �22
Area Drain Main Drain Fee
Water Leader Stove Drain Fee
Sprinkler Valve Water Svs. Fee / S"2
Gas Fee
Filter
Permit Fee 1 -2 011'
Total I IR L,2 2 e= I I Total Fee 1 3 7 `f0