51192.1N i
z
d -U
LOT NO.�
NO:.- ASn EF.T�
APPLICATION FOR PLUMBING PERMIT
Ilrsa
CITY OF CUPERTINO
IVO
p Sanitary No. -/'9 �3 •'
Date /VO 1/' �� ', 1961 Permit No 7V/?1Z
Pee S�
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 other laws applicable thereto.
Use of Premises
Owner C' /'N�q
By, �E�,?71r9L /A/C
CONTRACTOR, AGENT
Phone Zy A O f� fe
State License vr
Address' a !
Address Gas moi/-�,eLcT f -
SidN s%OSt
Approved WILLIAM D. 13ENEVICH
// \/ PLUMBING INSPECTOR
FIXTURES
NUM ER
MAIN DRAIN
Min
FEES
UNtrS FEES
Water heater
Hopper
Size / °
Size .[! / foo
Water Closet
Material6,a e-
3 -0O
MaterialC r
Bath 'rub
/
I-J-6
To Curb
Shower
Water Leader
A jv
To Prop. Line
Lavatories
3.
J"b
To F�istin
Kitchen Sink
71Not
Cann.
Dish Washer
1 Sewer Box
Comb.Sink R Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size / °
1/1-0
Restaurant Sink
Material6,a e-
Sand Trap
'TOTAL, FEES
Urinal
Fixture Fee Ja
Area Drain
Main Drain Fee 0`0
Water Leader
Storm Drain Fee
Relief Valve
Vac Breaker
Permit Fee