51167.1 (2)LOT NO. �Z:
NO. STREET
Ljr-ATION FOR PLUMBING PERMIT
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S T3{ OF CUPERTINO _
'0 Sanitary No. ^� "Z9 D
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o f Uate q ._1962 Permit No d //Z 6 7/
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w LL Fee $
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Ap c�t�Qn cry ity of Cupertino for a permit to install plumbing
o < pipes end/br atures`liit�d�r h le erre side hereof, and agrees to install said prices
> r 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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4 Use of Premises -
0 0'7-1� -*� �✓ � _ter
3Ownyq�¢�.��1L_/�.�7. Address
o By �/l/- Y ����%� 4 Address
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0 TRACTOR, AGENT �_
0 Phone
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a o State License 11AisJ� Approved
—U I J PLUMBING INSPECTOR r
FIXTURES I NUMBER II MAIN DRAIN
UNITS FEES 11 UNITS FEES
Material
Shower
To Pron. Line
Lavatories Z
To Existing
Kitchen ink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
,
Machine
Comb.Sink & Tray I 1 11 To Curb
Drnin
Size
Main Drain Fee
Storm Drain Fee
Water Sys. Fee
uas r ee
Permit Fee
Total j/ Total Fee