51001.2 (2) LOT NO.
NO. STREET
^� A_ �PPLICATIO'WFOR PLUMBING PERMIT
J � '� QITYOF CUPERTINO
(DEC 6 19F7 �. IJ sanitary No.
0 jDate /Z/� 1961 Permit No Sio o /, L
3 `
3/, 00
F o rjV QF r�IPERTINO Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
'o a 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
a w Cupertino, and all other laws applicable thereto.
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< r
j a Use of P mises
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3 wne ',6 Addres, ,
OJ
z B 4 • Address
O CONTRACTOR, AGENT
3r 6�3 —,13077
- N
Phone
0 w a WILLIAM D. S=NE1iICH
a "��f.'3.� Approved
a o State License
PLUMBING INSPECTOR I/
Its x
FIXTURES NUMBER MAIN DRAIN
UNITS FEES 11 UNITS FEES
Water Heater / I ISize
Water Closet 3 MNotConn.
Bath Tub
Shower Prop.
LavatoriesJr—
Kitchen ink /Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink 'Po Main Drain
Comb.Sink 81 Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TO'T'AL FEES
Urinal Fixture Fee AA go
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee G v
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 'Do
Total I Total Fee ?1,06