51189l
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No. Street
:aP KATION FOR PLUMBING PERMIT
�. GGG,ccml������W�'� � CITY OF CUPERTINO
1 ro E e 2� 1970 Sanitary No
Date t t � , 191 O
Lot No. Z %
Permit No. -"9
T r A ' ]rCtbby�r►bi DWa Fee $�S%
Cl
p scatM�s a City of Cupertino for a permit to install plumbing 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 Cupertino, and all other
laws applicable thereto. �y
Use of Premises AST 5 O U si /Tj
Owner IBQ./ Lp,JG'T. GO. Address ISI
By -5A -K1 JOSS F'1EC41Pxi-11LM, Pn16 AddressiLL� Q &Q -S Nr. SJ
Contractor, Agent
Phone '1'1 S � 9 0 4 � '����4A�✓
State License Approved
Xlambing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size P "
^0i
Water Closet
12
Material GI
Bath Tub
S
To Curb
Shower
b
To Prop. Line
Lavatories
i'L
To Existing
Kitchen in
Not Conn.
Dish Washer
Waste Dis oral
Wash Tra
STORM DRAINAGE
Washin Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Ho er
Size
I
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
S °%
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
S,
Relief Valyc
I
Gas Fee 1
v'=
Vac Breaker
Skimmer
Filter
Permit Fee 2 °�
Total
6
Total Fee
SV