51183 PLUMBINGLOT
NO. STR I. El
An, N FOR PLUMBING PERMIT
?AUGIT CUPERTINO
V Sanitary No. z'
Date � ��G 28 1958 Permit No. /l f
Fee $ Z6, / O
AppIgTYis®frebWiR� yi of Cupertino for a permit to install plumbing
pipes an`��1/or fixtures I o flI •����c'�1i7t Se 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 /�e la,T / 's-, t- �T
OwnerBy ��.
,C/ / C
CONTRACTOR, AGENT
Phone 4 —;[)o C)
State License. / 4/ I )U
Address, A 6 X 4S
Sar. Tos<P'
WILLIAM D. C!:CJ"—VICH
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 T
STORM DRAINAGE
Washine Machine
Size
Comb.Sink&Tray I M I HToCurb
Fountain
Size
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stonn Drain Fee
tleueI valve II',as Hee I L 6 U 1
ITotal 1 11 Total Fee =v, / v I