51179LOT NO. /V
NO. ZFrEE1'
APPLI ATION FOR PLUMBING PERMIT
z d f/%� CITY OF CUPERTINO
Y o + I (' I� Sanitary No.
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4 .:� AU a '967 p
o Date 1967 Permit No
30 ry 07
I1 v !�n..,.,.) PeeSo1?S✓=
Application is hereby made to the City of Cupertino for a permit to install plumbing
0 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
a w Cupertino, and all other I ws applicable thereto.
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Use of Premisesl��_ .�
00 p �
o4 Owne Addret��CJlYi//�
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By sz �N
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CONTRACTOR,
'CAGEN
z Phone
L�-ao State License ��CS'%� Approved
l - U PLUMBING INSPECTOR L
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FFEFS
Water heater
/ 6�
Size
Water Closet
.z
Material
Hath Tub
4i '
To Curb
Shower
/ /-jV
To Prop. Line !/
Lavatories
a-'
To Existing
' Kitchen Sink
/ e)
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&Tray
To Curb
Dental Unit
Drinkin Fountain
'
Floor Drain
WATER SYSTEM
Hopper
Restaurant Sink
al
Sand Trap
TOTAL FEES
1 Urinal
e Fee
Area Drain
rain Fee C.'fBD
Water Leader
Drain Fee
Sprinkler Valve
Water S s. Fee j
Relief Valve
Gas Fee /� n
_ Vac Breaker
Skimmer
Filter
Permit
Total
Total Fee