51181NO.
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Y° (FEB 21 1968
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3 a I)at GL.
LOT NO. —....1
PLUMBING PERMIT
Y I�PERTINO
Sanitary No
I Permit N
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w LL (� (� Fee $
ApplicationT YhS'mC f'b dRCIt�%G Cupertino for a permit to install plumbing
o a 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
a w Cupertino-, and -all-other laws applicable thereto. - -- -- --- _ - - -
.. Use of Premises ��•
00
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3
Owner
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BY
CONTRACT ,AGENT
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Phone
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f State License
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Addresso%7%Sk�'P ola riue.c �.>D
Address / --.?6
A, PLUMBING INSPECTOR v
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I FEES
VA
/. $ O11 To
;e 1'n
Kitchen ink / /•s° Not Cann.
Dish Washer Sewer Box
Waste Disposal / —o—
Tray
Washing Machine Size
11 WATER SYSTEM
Water Softener Material
Rapper
Bar Sink To Main Drain
Comb.$ink&Tray To Curb
Restaurant Sink
Dental Unit
Drinking Fountain
Sand Trap
Floor Drain
11 WATER SYSTEM
Rapper
Size
Restaurant Sink
Material a/✓.
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
,,fe
Area Drain
Main Drain Fee
o
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
So
Relief Valve
I Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total