51071OT
NO. J .F.l' i
CATION FOR PLUMBING PERMIT
O CITY OF CUPERTINO
® /�Sanitary Nu.
I i f
.. l D '` 1961 j Permit No S ly-21
Fee$5-'a
��W'lic j� n jj��� ��ryry the City of Cupertino for a permit to install plumbing
an{r fibJis �e.{IVhe 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
Cupertino, and all other laws applicable
thereto -
Use of Premises Z�iS r `IPwll��� `t/K;
A
By. �•��bUEIAs 1411A S
CONTRACTOR, AGENT
Phone �2 -,4'1 — 5-3 S X
'[ate Licensec3(c
AddressC.Jf1K1 wti k'
Approved WILLIAM D. 13EN'EVICH
PLUMBING INSPECTOR
FIXTURES
INUMBER MAIN DRAIN
Units Fees lUnits lFees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Pron. Line
Lavatories
To Existin
Kitchen in
Not Conn.
Dish Washer
Waste Dis osal
Wash Tra
STORM DRAINAGE
Washin Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hoer
Size
Restaurant Sink
Material
Sand Tr'
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
S�
M
Permit Fee o2. `2:
Total
Total Fee