51075.1 k /l y.5 O %•u f
LOT NO.
NO. STREET
A -PLICA"i"bEj'�j
0 PLUMBING PERMIT
IP CUPERTIN0
0 �MARf� 968l Sanitary No. J �^
LL
0 a Date "tea �/� ' 196 Permit No
w W QTY .O 0 t7���� �1� Pee $ /,S-7 ,sl
O Application is hereby mSd2'tb�t� Ilaty 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
a w Cupertino, and all other laws applicable thereto.
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,. Use of Premises
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3 Owner �c
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oBy. X9�i�Lu /Yke. (,ff-�yj/ ,••�f' Addressa/3.0
O NTRACTOR, AGENT /} y&J,
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- W Phoney
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ao State License /.''�,S 0 Approved
—U 1� PLUMBING INSPECTOR //
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water lleater / Size
Water Closet „?Olj Material
Bath Tab To Curb
Shower To Prop. Line
Lavatories o-_° To Existing
Kitchen ink Not Conn.
Dish her
Sewer Box
eal
6 STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tmy To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Si ze
Restaurant Sink Material
Sand Trap 'TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee T--
Water
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
r'iG� J7
.y
Permit Fee
Total Total Fee