51025LOT NO.
U]
J6TI FOR PLUMBING PERMIT
OF CUPERTINO
?FEB 27 1968 Lo sanitary No.
Date 196— Permit No. f—/, a S
CITY OF CUPERTINO Fee $oZ�2. s�
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 the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
By
CONTRACTOR,AGEN7T/
7 7
Phone
i
X..�'. 7 // '�
State License /24
Address /
AddressT'7
Approved h)6e.,.. v �G ,
PLUMBING INSPE OR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS
FEES
Water Heater
/
Size
Water Closet
.�
Material
Bath Tub
%
To Curb
Shower
/
To Prop. Line
Lavatories
:,'
To Existing
Kitchen Sinky
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
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material ,ryw
Sand Trap
TOTAL FEES
Urinal
Fixture Fee—
3—a
Area Drain
Main Drain Fee S 0 O
Water Leader
Storm Drain Fee
_Sprinkler Valve
Water Sys. Fee /
S-0
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee oZ
0 O
Total
/ '
'Total Fee
4