51075.4 (2) / rPOO6 / a/d
No. Street Lot No.
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L C BION FOR PLUMBING PERMIT
TY OF CUPERTINO
OCT 22 1970
Sanitary No.
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E Date� 4 e , [s1pg6_ Permit No.S/V 7S -lC
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1`��j VV Fee&,29
z, Application is hereby made to 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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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A .� Use of Premises
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° Owner ,e Address
g /f N uT=�v P e, v�lti
By x N • Address 0090 Bayshore Blvd
3 Contractor,Agent San Francisco
" ° Phone 826-6262
ro
— State License--Y Approve —
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To 1'ro . Line
Lavatories To Existing
Kitchen Sink NM C nn
Dish Washer
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
fflDrain
WATER SYSTEM
Size
ink Material
Trap TOTAL FEES
Fixture Fee
Main Drain Fee
Storm Drain Fee
Sprinkler System Water Sys.Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee