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NO PERMIT NUMBER
LOT NO. h0. STR F.F.I' I �FOR PLUMBING PERMIT v CUPfRTINO Sanitary \o. JVAPR 5 10 OF ° � - +� 0 ' Date 196— Permit No 3 a TT�/ (� n�©TIn (� LL p t k nQF p' 'P 2 JRo Pee i 7 O� � ° A i a io he I t Gty of 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 <w Cupertino, and all o (eerr laws applicable the ltf.' ) a Use of Premises ✓./_ le/C� SE4/ Q.(wy J 4 20 3 Owne�af I / AA --*07R Address o� (� z N4 VN v �� S,+m Address BY ° 3�•�t CT�+�t 3 am Phone Z.Q (►"�.ZCg w Z F State License ,.C�!L_ X417 Approved go U PLUMBING INSPECTOR FIXTURES NUMBER MAIN DRAIN UNITS FEES UNITS FEES Weter Heater Size Water Closet Material Bath Tub To Curb Shower To Prop. Line Lavatories To &istin Kitchen Sink Not Conn. Dish Washer Sewer Box Waste Disposal Wash Tray STORM DRAINAGE — Washing Machine Size Water Softener Material Bar Sink To Main Drain Comb.Sink&Tray To Curb Dental Unit Drinking Fountain j Floor Drain WATER SYSTEM Hopper Size Restaurant Sink Material Sand Trap I'0'I'AL FEES Urinal Fixture Fee Area Drain Main Drain Fee Water Leader Storm Drain Tee Sprinkler Valve Water Sys.Fee Relief Valve Gas Fee Vac Breaker Skimmer Filter Permit Fee Total Total Fee