NO PERMIT NUMBER (2) LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
<' ITY OF CUPFRTIN0
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Sanitary No.
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O < Date_1� ID6- Permit No
�U 1NOV 14 1967 Fee $ `S�
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and tudis v r side hereof, and agrees to install said prices
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an
fixtur s in kttcord'atuFi fHC1� visions of the Plumbing Code of the City of
a w Cupertino, and allothe� Laws applicable thereto.
~ ~ Use Of Premises
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7 ?9S ter/
3 Owne�/r i/ �� Addres
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J z By - / Address
O CCFNTRACTOR, AGEN
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rca �.>'GL��9 Approved WILLIAM D. DENEVICH
a o State License
LI. -U PLUMBING INSP$CTOR ��
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UN I"S FEES
water-Heater Size
Water Closet Material i
Bath Tub % To Curb
Shower % To Prop. Line t/
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 TO'T'AL FEES
Urinal Fixture Fee GS"
Area Drain Main Drain Fee Q�
Water Leader Storm Drain Fee
SprinklerValve Water S s.Fee X,3-?r
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total ,S Total Fee