5103902/ 90 3 I `l LOT Nn.
NO. STREET orl
fAPPkI;dWTIgNgFOR PLUMBING PERMIT
.i Z�==�� I;Y� OF CUPERTINO
fSEP 25 1967 ��.: sanitary No.
Date 196— Permit No .Tio 3 9
nn pp[[pp7 n Fee S //
A�'pl�atior>t,lcheUfnhdc� 10city 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 provisi of the Plumbing Code of the City of
Cupertino, and all other laws applicable t
to
Cupertino,
Use of Premises •
Owner /4//e'C'E2 L Address 22 9O3llin>,�
By /Sf'�C �'� r �-ei Address 5 - 7
CONTRACTOR, AGENT
Phone
State License t 3 3 �Z> App,
INSPECTOR /
FIXTURES I NUMBER �� MAIN DRAIN
UNITS FEES UNITS I FEES
Water
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
IIJif\I►1
Size
Comb.Sink & Tray I I I I To Curb
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee 0-0
Area Drain
Main Drain Fee
Water Leader
Stotm Drain Fee
S rinkler Valve
Water Sys. Fee Z.ry
Relief Valve
/ w
Gas Fee ,1"D
Vac Breaker
i f�
Skimmer
/ J�
Filter
/ J�
Permit Fee oZ Clu
Total
6.0 0
Total Fee
.��
r
LOT
NO. STREP.I'
® N FOR PLUMBING PERMIT
z
� a .It CUPF.RTtNO
i
r 0 I,Sanitary No.
3u
o a Date L Permit No, _J loo
LL. �T Y OF Fee S —, W
r o Application is hePPr T(ft City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on �iP�feverse 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
i w Cupertino, and all other laws applicable thereto.
W x
r r
0 0 I
O O
FEES
Sewer Boxes
xture
klcr
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.Main Drain
Final