51179-t7`�G— LOT NO.
STREF.IV
APPLICATION FOR PLUMBING PERMIT
'z z1968 CITY OF CUPERTINO
xp;��V _ Sanitary No.
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0 a Date/�3TMt �' 196 Permit No S�/ �`L_
3 U .��r irUt Fee S.-3 •,60
0
Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all laws applica le hereto.
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Use of Premises
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O C NTAACTOR, AGENT
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State Approved
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—0 PLUMBING INSPECTOR
FIXTURESNUMBER MAIN DRAIN
UNITS FF. F.S ITNITS1 FF:F.S
Material
Shower
Kitchen ink Not Conn. I
Dish Washer Sewer Box
Waste Disposal
Wasbin� Machine �� Size I
Water Softener \'laterial
Comb.Sink&Tray I 1 11 To Curb
Fountain
Floor Drain I 1 11 WATER SYSTEM
Valve
Total
Alow.]m
Main Drain Fee