51167.1 (2)F
tlF a O
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LAT NO. j' 0
NO.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
Date 1961' Permit No .-//6 7,/-
Fee
,/Fee $ a 3 .S'J
Application is hereby made to the City of Cupertino for a permit to install plumbing
andP
i cs and�or-fixtures listed on the reverse side hereof, and agrees to install said rices
'ofi^lure's
inrdancc with the provisions of the Plumbing Code of the City of
Cupertino, ynd_all_ctt�her la. , applicable thgreto.
Phone -2r 33 `2
State License
Address
'�
Address
WIL.L..LAM D-
PLUMBING INSPECTOR r/
FIXTURES
NUMBER
MAIN DRAIN
_
UNITS FEES
UNITS FEES
Water Heater
WATER SYSTEM
Size
Water Closet
Restaurant Sink
Material Ci ,
Bath 'Cub
/
To Curb
Shower
Area Drain
To Prop. Line ./
Lavatories
2�
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Filter
Wash Tray
STORM DRAINAGE
Washine Machine
i
Size
Comb.Sink & Tray
To Curb
Dental Unit
_
Drinkin Fountain
Floor Drain
WATER SYSTEM
IIo per
Size
Restaurant Sink
Material
Send Trap
TO'T'AL FEES
Urinal
Fixture Fee G
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
Total G+
S Total Fee .?3JZi