51022 �� y�l rJ I/v,'w,�✓lM 1' .✓ pcf"�• LOT NO.
NO. STREET
G N AP-TA TON. PLUMBING PERMIT
C�'IIP Ol CUPERTINO
Y o ?111JUN 11 1968 Sanitary No.
- `Y
o � Uate 196— Permit No O
50 _
r o PITV V Or In ��rpTl��n Fee S -
Application Is hereb� 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
b'raw Cupertino, and all other laws applicable thereto.
w
� r
Use of Premises
00 „
- 3 Own�er�� !l L'.Lti �r ,//� • Address ,1 44-' '.
oz Dy /i../ �.JF/"✓'�%!Yt^d� C-/4-0— Address'A-
O CONTRACTOR,AGENT
3 �
- < Phone 3.�/-�.� V3 73Y
a o State LicenseApproved
�C -U PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNIT FEES
Water Heater Size
Water Closet Material e dy
Bath Tub To Curb
Shower To Prop. Line.
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tro STORM DRAINAGE
Washing Machine Size
Water Softener , Material
Bar Sink To Main Drain
Comb.Sink&Trey To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTA r EES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fe
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
X
c� Permit Fee
t7t7
Total 7 Da as'� Total Fee S�d