51192 (2)M" 17t i L 1 is Kr Ct. LOT NO. �y
NO. STREET
APPLICATION FOR PLUMBING PERMIT
® .. �� CITY OF CUPERTINO
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Sanitary No.
o :1Date 11966 3-� 1969 Permit No ��/ `7 2_
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Fee $ `� S • � �
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse 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
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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3 Owner' bl E S Address
o J ira /n -p gym
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O CONTRACTOR, AGENT 625 Charles Mee55
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—< P1one2q;F— &C—_rG SaaJnse California 95112
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f State License. 17�s-3% Approved WILLIAM D. 6ENEVICH
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— U JC PLUMBING INSPECTOR f/
FIXTURES I NUMBER II MAIN DRAIN
k)G—IR I UNITS I FEES 11 UNITS FEES
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
WashinaMachine I I I /.SD 11 Size I I
Comb.Sink & Tray I I I To Curt/
Floor Drain
WATER SYSTEM
Hopper
Size
go
Restaurant Sink
Material
I.
Sand Trap
TOTAL FEES
Urinal
Fixture Fee ,<-,on
Area Drain
Main Drain Fee S n
Water Leader
Storm Drain Fee
Sprinkler Valve
Watera. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �, _ 0 d
Total
/600 Total Fee o1