NO PERMIT NUMBER�L Pq'-- LOT NO. �+
NO. '1 \\ `ter STREET
K�APPLICATION FOR PLUMBING PERMIT
m Z '� AUG 1 igGb71TY OF CUPEiRTINO
r a Sanitary No.
OJ Date p •r -�^ ---, 196_ Permit No
3 U - 7 Fee $ oZ9 S—o
2 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
> r 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.
wx
0 LL Use of Premises
T
00
3 Owner V Los V Address
oa
ZJ
3 r pCONTRACTOR, AGE
— < Phone 625 625 Charles Street
.z San juse California 95112
as� WILLIAM D. SENEVIC
Q o State License �— Approved) /
1� - U PLUMBING INSPECTOR/
i�
FIXTURESNUSIBER jiWr MAIN DRAIN
UNITS FEES UNITS FEES
Bath Tub To Curb
Shower ' 3 �a To Prop. Line
Not Conn.
Sewer Box
Wash
Size
WateiSoftenee -- {
Comb.Sink&Tray I 1 11 To Curb
ng P ountmn
Drain
Size
urinal
PIxture t.ee
I
Area Drain
Main Drain Fee
Water Leader
Stonn Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
, v-0
Vac Breaker
Skimmer
Filter
Per7 D
mit Fee y6 O I
Total 3 /q to Total Fee -y.J'