51025 /Ot LOT NO.
NO. 5TR EEI'
I - ION FOR PLUMBING PERMIT
w d C (. �OP CUPERTINO
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s o ® Sanitary No.
0 ' bate I MAY 6 1968 + %_ Permit No D RS�
3
wLL Fee $J9 �
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A � ro ey�,�SL t City of Cupertino for a permit to install plumbing
o a pipes at i or I ture3'h�sFe ltth����verse side hereof, and agrees to install said prices
r 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.
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Use of Premises
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r 3 Owner Address
zBy / / /,1�I��/�CC/7�L Address
O / , CONTRACTOR, AGENT
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w w Phone—. �' /,i 7 v
r s State License 4L`J ApprovecI429a2v=
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Renter Si ze
Water Closet Material C
Bath Tub / To Curb
Shower To Pro . Line
Lavatories O To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine „J'b Size
Water Softener Material
Bar Sink A TV 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 i 0
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee goo
Total Total Fee a