51179� iI LOT NO. �
NO. STREET
PP¢,f,(1T FOR PLUMBING PERMIT
CUPERTINO
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r o Sanitary No.
a a Date 4 1967, , Permit No. S//7
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u Fee �
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° Applic�yib�iys I,Dby tA'y1Ly-� � of Cupertino for a permit to install plumbing
0 : pipes and/or fixtures Iiste, oi' hi''r� side hereof, and agrees to install said prices
I 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.
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Use of Premises
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0 < Owner Address
z By ..�//ll�/ Address
° CONTRACTOR,AGENT
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0E State License ��G S7/� ApprovedVi7_L{AM D. SENslyff- F
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— U PLUMBING INSPECTOR t ✓
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
Material G .
Bath Tub
To Curb
Shower -
/
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
}Topper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
I Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee ,2p-e
Total
.2— 41'ea
Total Fee ��fl