51167 (2)21 i1SZ I 6&&213 V S LOT NO.
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-< APPL'ICATIQW.FOR PLUMBING PERMIT
CITY dF CUPERTINO
(MAR 26 1968 UL" Sanitary No.
Date 2-S 196.Q Permit No •r// �v
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r.Tv
OF CUPERTI O Fee $ (f, —
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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.
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Use of Premises
Owner►{dZnZ
6y 1 0 O e
CO. RACTO R, AG F.NT U r/
Phone-',I%S�J
State License. 190 - /7 �:
Address 206 2 fQ/unj?JS
QQAddress fOS r!Oni,is ♦7TC /A
RI
Approved
PLUMBING INSPECTOR J
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tra •
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.SinkRTray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER 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
S?.
Gas Fee
Vac Breaker
}'*
Skimmer
s
Filter
Permit Fee o2.
Total
i
Total Fee er a,