NO PERMIT NUMBER LOT NO..2 V
. TRE J s
4PP0dAC T ON FOR PLUMBING PERMIT
11 z d e n CITY OF CUPERTINO
w \ t MG ; 1"68
x p Sanitary No,
p LL
3 U Dat( ` Jll -- - .196— Permit No _
w Pee 3a f . ✓tl
x LL
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o 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
a w Cupertino, and all other laws applicable thereto.
w x
~ ~ Use of Premises Dw8111ng
a
J 4
n p[
oa Owner Dj-tz—Gra= C0MPA Y 2 Gd'resssse L8 Cruz Boulevard
z n Palm Plumbing Company � tl4� ,§ ale-Saratoga Rd.
� O y CONTRACTOR, AGENT
3Phone 24.5-2323
— m
w w WILLIAM D. SENEVICH i
f State License 186579 Approved
a o
—0 PLUMBING INSPECTOR
J
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNI S FEES
Water Heater Size
Water Closet V' Material /
Bath Tub To Curb
Shower / To Prop. Line
Lavatories L To Existing
Kitchen Sink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine J Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WA'T'ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
ZEiiw-
Total Total Fee