No Permit Number (3) LOT NO. c:Z J
E<OkICATION,FOR PLUMBING PERMIT
a CITY OF CUPERTINO
I o fQUI_l z 1968 t� Sanitary No.
0 a Datp v ��G, 196 Permit No
W W Fee $ .78.eo
7
O 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
Z and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all other laws applicable thereto.
W I
LL Use of Premises A'oe:-
00
3 Owner_/ . L/Al0 S 4^^}� Address
?= B Address 7 J' Cff�e fT
0 y OR. AGENT
— 0
7<%F OJ i7 ld
Phone WILLIAM D. EIENEVICH
wo a o J
State License 7� �3 7 Approved J
_U X PLUMBING INSPECTOR [ /�
FIXTURES NUMBER MAIN DRAIN
UNITSPFEES UNITS FEES
Water Heater Size 44 1 40
Water Closet 3 Materiel . %Bath Tub To Curb
Shower To Pro .Line
Lavatories rl To ExistinKitchen" 'ink L Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine o Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Cur
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size A
Restaurant Sink Material c— IJo
Sand Trap TOTAL FEES
Urinal Fixture Fee _
Area Drain Main Drain Fee r
Water Leader Storm Drain Fee
Sprinkler Valve Water a.Fee fD
Relief Valve Gas Fee O
Vac Breaker
Skimmer
Filter
Permit Fee
Total Y �-0 Total Fee fid;M"