51167.2M/__�f /_%. LOT NO.
NO. by STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPF.RTINO
,® Sanitary V'o.
Date!), Jl --� 1968 Permit No -S114ri
1
(JUL. 3.1 1968 1 L Fee $a6
Application is hereby made to the City of Cupertino for a permit to install Plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
anoy,J7Dfixtumr inmceordance. with the provisions of the Plumbing Code of the City of
Cupertino; and all"rotbir_iawu4 i
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS I FEES
Water
Shower / To Pron. Line
Lavatories To Existing
Kitchen Sink H Not Conn.
Dish Washer Sewer Box
STORM
Machine
Comb.Sink & Tray To Curb I
Dental Unit
Floor Drain I 1 II WATER SYSTEM
FEES
Water Leader
Relief Valve
Main Drain Fee
Water
Permit Fee
Total I // V/��� Total Fee