511714S -D I Z/ . �. Itl -t I e? LOT
NO. L i STREEI ji
APPLICATION FOR PLUMBING PERMIT
6TY OF CUPERTINO
Sanitary No.
V�'
Date A"' --�, 196-7 Permit Noc/
C Fee $
CAp�liC�4n i.0,'L RTjVtt0the City of Cupertino for a permit to install plumbing
pipes and/or fixtures liste 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
Cupertino, and all other laws applicable thereto.- - -- - -
Use of Premises
Owner 7W,�11 4
Byl/I,14 GLrl Ce � Pke-'C �
CONTRACTOR, AGENT
Phoney ,7 � ' 7 2—
State License } C
Address
Address/moi
Approved
410 PLUMBING INSPECTOR ��
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
Size '
Water Closet
Material G
Bath 'rub
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
Drinkin Fountain
Floor Drain
17 WATER SYSTE6'I
Hopper
Size
Restaurant Sink
Material
Sand Trap
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee ♦ O 0
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee V*
Total
Total Fee , Q