NO PERMIT NUMBERN
wz
LOT
NO. STR F. FT
APPLICATION-' ,OR�,KVMSING PERMIT
CITY OF CUPLRTIM �1
pt
/OCT 25 1968San1tary'No.
Date 2 Y 196ff Permit No
OF CUPFRTI I' f Pee $ oZS d—tJ
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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all o tier ,s applicable thereto.
Use ofPre es—'—/'J--��
Owner,
�t�D`C17C Address
By. '�i—e4.1 /:�� Address
CONTRACTOR, AGBJT-
State
oved
\ PLUMBING INSPECTOR
FIXTURES I NUMBER MAIN DRAIN
UNITS FEES 11 UNITS
Water Closet
'Y
1- "11
Material CY ,i
Bath Tub
/ S
To Curb
Shower
J
• S -V
To Prop. Line
Lavatories
ry
To Existing
Kitchen ink
�. 3
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash TraySTORM
DRAINAGE
WashingMachine
/
/„gyp
Size
Water Softener
Material
Bar Sink
/
A 4'0
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size %
f• 0
Restaurant Sink
Material
Sand Trap
•l'OTAL FEES
Urinal
Fixture Fee
- O-0
Area Drain
Main Drain Fee
.i- &.0
Water Leader
I
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
'• S O
Relief Valve
Gas Fee
!•1 0
Vac Breaker
Skimmer
Filter
Permit Fee
•0-0
Total
/D
%,i^PD
Total Fee -2-
j • 1�0