510380�o-L-
L
L I LDS D/t(G( /�s LOT
NO. STREE.I'
in ICON FOR PLUMBING PERMIT
y� C
OF CUPERTINO
�J _ Sanitary No,
�
Date Permit N
Pee
%0-3
3 S—o
Alajil� tybn(t}[�erfs "IdpTL ity of Cupertino for a permit to install plumbing
pipes lure � t erse 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
Owner R `D 6 N L Address n' /
By 6 Address_
CONTRACTOR, AGENT
Phone:1- S 2 ---3 9 6
State License / 2 37c12---
Approved
PLUMBING INSPECTOR
FIXTURES I NUb1BER �� MAIN DRAIN
UNITS FEES UNITS I FEES
Kitchen ink
Dish Washer
Waste Diana;
To ProD. Line
Material
Comb.Sink & Tray � I I To Curb I I U
Fountain
WATER
Si ze
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader 11 Strom Drain Fee
Total