1131No. alxeer �:� -
® �T FOR PLUMBING PERMIT
' !S+JUN 6 1961 OF CUPERTINO
Date 196 / Permit No. / Alz
CITY OF CUPERTINO Fee $''9, DD
Application is hereby made to the City of Cupertino for a permit to install plumbing
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 lumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
O n 10&. Address /lam C
I �By _ Address
'
j �� CONCTOR, AGENT
H'ho -p 2 _ APProved
', PLUMBING4INS,fPECTOR
FIXTURES NUMBER
MAIN DRAIN
UNITS FEES
1UNITSI FEES
Water Heater
Size
Water Closets
Material
Bath Tubs I �I
To Curb
Shower4
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
Not Conn.
P
Dish Washers
Waste .Disposals
SEWER BOXES
Wash Trays
STORM DRAINAGE
Washing Machines]
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
ISI
Drinking Fountains)
Floor Drains
WATER SYSTEM
Hoppers
Size
I_
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee ��
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler Varves I
II Water Sys. Fee I ?.
An I ?
TOTAL �' I 1
ermit Fee
11 TOTAL FEE R , Xv