51167.1 (2),7A,-73 I / `- N ¢ 0k. LOT NO.
NO. STREP.I'
Rt_,AP.PLIC- TION FOR PLUMBING PERMIT
S
C I I�1
Y OF CUPERTINO '/22 1967 L ' sanitary No.
Date -1962 Permit No
A
Fee S 4
pp ti®is HDp,nhe
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, anti all othe aws applicable thereto.
Use of Premises T.�it���lnrir
Owner���',F - Address
/W- ic�J
By� ` 2 Address
CONTRACTOR,AGEN -
Phone
WILLIAM M. T-"NElfl--H
State License. ��G✓� �9 Approved
PLUMBING INSPECTOR
FIXTURES NUMBER —MAIN DRAIN
UNITS I FEES_ UNITS FEES
Water Heater - ik;;,P 144 1
Water Closet
<i
Material (i ,
Bath Tub
To Curb
Shower
To Prop. Line v
Lavatories
To Existing
Kitchen Sink
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
Sand Trap
TOTAL FEES
Urinal
Fixture Fee ,52
Area Drain
iI ain Drain Fee '
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
/
Total Fee