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NO PERMIT NUMBER 451 LOT NO. , NO. STREET APPLICATION FOR PLUMBING PERMIT CITY OF CUPERTINO Date Ju,, 24 195'S7 Permit No. f O 111 SEP'." n 195 _v, Fee $ 3 .-, Applicatio q`Zs hFreby made the City of Cupertino for a permit to install plumbing pipes and'Jbr fi es list�d'�ifll a everse 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. v &' Use of Premises 0 h Owner R. D. Koenitzer, Jr. Address I OD69 Phar ran nr. By Ra a W'te'r �nnditioninaidllk Address 243—B Mgffea Blvd- CONTRACTOR, AGENT Wf SP• ' I Phone967-4545 Approved • 17Q- PLUMBING INSPECTOR ,� FIXTURES NUMBER MAIN DRAIN UNITS FEI?SUNITS FEES Water Heater Size Water Closets Material Bath Tubs To Curb Showers To Prop. Line Lavatories To Existing Kitchen Sinks Not Conn. Dish Washers Waste Disposals Wash Trays II STORM DRAINAGE Washing Machines Size Water Softeners 1 I4-®© 11 Material Bar Sinks To Main Drain Comb. Sink & Trays) To Curb Dental Units I ` I Drinking Fountains) II I Floor Drains WATER SYSTEM Hoppers Size Restaurant Sinks Material Sand Traps TOTAL FEES Urinals Fixture Fee Area Drains Main Drain Fee Water Leaders Storm Drain Fee Sprinkler Valves Water Sys. Fee Permit Fee TOTAL TOTAL FEE RECORD OF INSPECTION Partial Rough Rough Complete Final