51167.1, � �(/ 1 O st !L/ / lTi�/ LOT NO A
NO. ST EE.T
APPLICIATIOB.N FOR PLUMBING PERMIT
CRI OF CUPERTINO
i 2 2 1967 ��� i Sanitary No. S—// 7
Date 1962.Permit No
Fee $,2 G SZ
r'TV �� rl DrQYjMr)
Appbcation i's hereby madeito the.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 otherLaws applicable thereto.
Use of Premises
State License
Address
zl;�.3� %
Address
PLUMBING INSPECCOR 11
FIXTURES I NUMBER II MAIN DRAIN
[UNITS I FEES 11 UNITSFEES
Shower � / I it To Prop. Line I //
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Size
Comb.Sink&Tray I 1 11 To Curb
Drinking Fountain I H I 1 I
_Floor Drain WATER SYSTEM
Hopper Size I I
Fee
Area
Total
cc