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APPLICATION FOR PLUMBING PERMIT
fMARCITY OF CUPERTINO
12 1968 t. Sanitary No,
Date�•—• • -3h 196F Permit No j-//% 2
Ci- f_It�iPY R��,.9 Fee$
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.
th
Use of Premises IC'' IIrs
Owner�ti 40MES Address
By r ss
CONTRACTOR, AGENT 625 Charles Street
Phone .29 8— os5` San Jose; California 95112
State License 171637
WILLIAM D. SENEVICH
PLUMBING INSPECTOR
i
FIXTURES
NUMBER
MAIN DRAIN
UNITS I FEES
11 UNITS
FEES
Water Heater
O
Size 41,
ssa
Water Closet
L4 SSD
Material C
Bath Tub
To Curb
Shower
/ � p
To Prop. Line
Lavatories
r( nn
To Existing
Kitchen Sink
5p
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
1 Sr7
Size
—"
Water Softener
Material
Bar Sink
To MaiwKnin
Comb.Sink&Tray
'Co ab
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
I Material
..•...� ),,..
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
An
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee In
Relief Valve
Gas Fee �,
C7l
Vac Breaker
Skimmer
Filter
Permit Fee '
/f
Total
/I;)—
Total Fee ,fig
D