NO PERMIT NUMBERa 1` 7 l IJ `Y LOT NO.
No. STREET'
APPLICATIOi�� $ING PERMIT
bat Irary, No.
nate 3 0 YKEP,969M 1968 �P�m;t Np
Pee $ oC(a•�
Application is hereby ma'ite" b t{2 dy 'E r0 5 por,o�,or a permit to install plumbing
pipes and/or fixtures hste'dton'the rever e side hereof, and arees to install sid prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
I -U
State License A'? R93%f—
XPLUMBING INSPECTOR
FIXTURES I NUMBER I� MAIN DRAIN
UNiT$ PEES _ UNITS I FRES
Water
To
Kitchen $ink Not Conn. I I I
Dish Washer£ Sewer Box
Waste Disposal
iu001IF.1lklrlv�
Material
Comb.Sink R Tray I I II TQ Curb
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
0 0
Water Leader
Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
QO
TotalTotal
Fe ,r0