5117914
"�wz/ I A��fc� LOT NO. /
NO. S7AEE1'
LI1 FOR PLUMBING PERMIT
[i� OF CUPERTINO
jyI 4J� Sanitary No.
Date" I/' 967 Ll 6� Permit No –5-11 -7 5%
Pee $ 5Q3 S �
A�ijtil io�ishe ,RTMCity of Cupertino for a permit to install plumbing
pipes and/or fixtures IistecdT 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
Cupertino, and all other laws applicable thereto.
Use of Premises
,/���l Address
sy Ilex, 3�-'2� .i Address i�?
``CO//NTRACTOR, AGENT
Phone �'7'�.J`i 1_3-2,3
State License 1-1�10 S �X — Approved WILLIAM D. 13ENEVICH
PLUMBING INSPECTOR j/
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet-
Material Li/•
Bath Tub
To Curb
Shower
/
To Prop. Line
Lavatories
--2—
-ml-Existing
Kitchen Sink
Not Conn.
Dish Washer
H 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
Size
Restaurant Sink
Material
Sand Trap
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
_
Storm Drain Fee IrV
Sprinkler Valve
Water Sys. Fee /,
Relief Valve
I Gas Fee
Permit Fee
Total Fee