51167//Ioe 7
h0. STI EE.T
,rAPPLI XTION FOR
� �:ITIY OF
Date IN
1967
LOT
PLUMBING PERMIT
CUPERTINO
Sanitary No.
Permit No ��1 G 7
Fee $311,-Q-
A(iphptiCnlis hrjt�PP ff t6l6 �e City of Cupertino for a permit to install plumbing
pipes and/or fixtures` liste E n 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.
Use of Premises - 1!4,1,w 4e
Owner
//./ t e�r ."" r
By W17Q!- H; t* -SI A W71eV
CONeACTOR,AGENT
Phone --9'7 C --%S
State License I7 /V 5 i"c)k
Address 11V Yq/a' C'✓0105 Lir.
Address�Or., .SvcrSOe-
Approve *41444�
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 Tra
STORM DRAINAGE
Washin Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&'I'ray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYS'T'EM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL. FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Stom Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee