51003 /V SSS I bLKE� LOT NO.
No. STItEE.I�
'1 eAPPLIC�AT ^WF R PLUMBING PERMIT
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' CITY OF CUPERTINO
xo ��EP B 1967y
Samtar No.
o a Date 196--;7Permit No
Si o a 3
34 C'TY 0r tjPEtD 1;I Fe' s /�Ud
i o I I�hereby e t l�
Application Is hereby made to fhc City of Cupertino for a permit to install plumbing
`opipes 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 m Cupertino, and all other laws applicable thereto. /J
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u E State License .20 9.9aa Approved(N
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PLUMBING INSPECLO i%
FIXTURES NUMBER MAIN DRAIN
UNI'T'S FEES 11 UNITS FEES
Water Ifeater 11 Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To F.xistin
Kitchen ink 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&'Gay To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TO'T'AL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee %
Relief Valve /.Sz Gas Fee
Vac Breaker
Skimmer S�
Filter $'r,
Permit Fee o2
Total �� Total Fee p o