51088.1 \� �A'PPLICATION"FOR PLUMBING PERMIT
z < CITY OF CUPERTINO
aAUG 12 1968 sanitary No.
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o Date196, Permit No
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
`o 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
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Cupertino, and all other flaws applicable thereto.
Use of Premises
00 �� i
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0 3 Ow -icener Address
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By Address
CONTRACTOR, AGENT
3 W �— � Z,Q
— `z Phone 7
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0 f State License�f 3-3�2- Approved
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0 PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS1 FEES I 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
Washing Machine 11 Size
Water Softener Material
Bar Sink To Main Drain
Cotnb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size ( �
Restaurant Sink Material '
Sand Trap ( TOTAL PEES
Urinal Fixture Fee a O d
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee Oa
Total Total Fee O D