NO PERMIT NUMBER (3) 101W 0'- RI C b AL
NO. STREET
�zAPPLICATION, FOR PLUMBING PERMIT
z aCUPERTINO
w z CITY OF
x o .,) i AUG 1 Sanitary Nu.
QLL Q
0 Date V 1960 Permit No
a
3 LL n r— vn• Pee $ a SJ J
To
� 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
U)
Cupertino, and all other laws applicable thereto.
LL Use of Premises
00
> m
3 Owner Address
6' 9nc
By re"
3 r CONTRACTOR, AGENT Char es f
— < Phone R,O SS6 San Jose, California 95112
. Z WLL UAM D. HENEKLCH
a a State License �7��..�/ Approved
A U y PLUMBING INSPECTOR
C /�
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FETES
Water Heater ,50 Size all 1
Water Closet .d0 Material e�'i
Bath Tub To Curb
Shower e 50 To Prop. Line
Lavatories 3 0-�5D To Existing
Kitchen Sink .�50 Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine ..� Size
Water Softener Material
Bar Sink To Main Dra'
Comb.Sink&Tray 1110 C
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
}Topper Size // k0 1
Restaurant Sink Material /J
Sand Trap TOTAL FEES
Urinal Fixture Fee / OQ
Area Drain Main Drain Fee Sao
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee SID
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee a- 0(�
Total /0 1500 Total Fee oz