51089.1 (14) �'ee 1 to
LOT NO.
NO, STR EF.i'
AP;PL- CAJiRN OR PLUMBING PERMIT
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0 Sanitary No.
3a Date / 31 1968 Permit No. dmow/dgrf /
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r ° Application-is herebomade'IoIthe-� f Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on'`tHjGevc# psf je hereof, and agrees to install said prices
> and/or fixtures in accordance with the pr;vIslons of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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� n Use of Premises
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3 Owner Lm ` c,tvST � Address ��1 �VMTACR,4 CIV
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� z By a?-Q it � 1 L Address 9 kn!aF%m VK lYs n
O CONTRACTOR, AGENT
3N Phone
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ui State License �ZC) Appr,MLLt"•+ n =rNtv......,
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—U PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
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
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve f /S—O Gas Fee $—O
Vac Breaker
Skimmer
Filter y
ermit Fee o-0
Total [T�otal Fee �7