NO PERMIT NUMBER (2)r j
21452 I Elm Court LOT NO.
NO. STREET -
APPLICATION 6PLUMBING PERMIT
W Q T Ug�r.ryyrl
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30 a Date October 18 N6§ tNo
_ 1968
w Fee Q 3. 50
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Application is hereby nt3t1 'tp,P tLMr�dy�'f+f' �+PP��{{ f r a permit to install plumbing
o r pipes and/or fixtures hstcldlonithhver5el�id7(�i �d agrees to install said prices
a 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.
W
LL Use of Premises Residence
00
' W3 Owner Wallace Martin Address 21452 Elm Ct_
0 a
z_j Culligan Water 611 University
J z By 9 Address611
0 CONTRACTOR, AGENT Los Gatos Calif.
3 < Phone 354-1845
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wz
R 6 State License 216217 Approved \1rILL1.".:I D. '.1'?._ ....I
a,01'
—�✓ PLUMBING INSPECTOR
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 Tray STORM DRAINAGE
Washing Machine Size
Water Softener 1 1.50 Material
Bar Sink To Main Drain
Comb.Sink&Tray 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 I
Sprinkler Valve Water S s.Fee
Relief Valve Gas Fee
Vac Breaker {
Skimmer
Filter
Permit Fee 2.00
Total 1. 5q, Total Fee 3. 50