51167.11-
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4
NO.
�1 WP�LICATION
CITY
LOT NO. 4:=
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
Date �'� , 1962 Permit No 5-11471
Fee $ o2 �o SS
^ITV O°' I f?m-,rd omi
Application IS h�ieby made to .the City, of Cupertino (ora permit to install plumbing
pipes and/or fixtures listed 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
Phone�Sl-��'-�
State License.
Address ?
Address
Approved
WILLIAM p, pgNEVICH
PLUMBING INSPECTOR L/
_FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
11
UNITS FEES
Water Heater
I
ISize
.54
Water Closet
V'
Material
eS/
Bath Tub
To Curb
Shower
/
To Prop. Line
✓
Lavatories
To Existing
Kitchen $ink
/
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
G a
Area Drain
Main Drain Fee
3I
Water Leader
Stom Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
_
Filter
Permit Fee
Total
W.jp 11
Total Fee
GS21