5117507
NO. STI EEI'
LOT
3 S'
AP ATION�OR PLUMBING PERMIT
z z KITH ,OH CUPERTINO
Y° /JEP Sanitary No.
LL 15 1967 Li
° a Date 96 Permit No7S-
3 U � 5�
° ApplUtwn isUiFeb}rAWERjW ty of Cupertino for a permit to install plumbing
o w pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w x JJC
� r
JLL
Use of Premises _
O O
3 s
Owner Addres//
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o By Address—S-1
3 F CONTRACTOR, GENT
— 0 Phone 3 iq
¢ a
�L < a State License? D eld Approved
p
—0 PLUMBING INSPECTOR ✓
x
FIXTURESNUMBER �� MAIN DRAIN
UNITS FEES UN'.
Material
Shower
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Washing.Machine
H Size
Water Softener _
Material
Bar Sink
To Main Thain
.Comb.Sink & Tray
To Curb
—
Dental —Udit-
Drinking
Unit—DrinkingFountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee -`—
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee i S
Total