51046 !L� G ! 61 -I4l%�C.c.`.CrY�s'e /4 LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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d CITY OF CUPLRTINO
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r a Sanitary No.
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3 < DatS 1196— Permit No
wU SEP 8 1967 11": Fees 7
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pip /o to 11 reverse side hereof, and agrees to install said prices
> an � xlutlTinla /'di c��.�(fi lJhe provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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3 OwnerAddress
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O CONT RAC"TORR, AGENT
w i Phone7 N7TA`
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a o Stale License Approved
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I� _U PLUMBING INSPECTOR
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 Storrs Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total I Total Fee 1 7 4 t