51167.1LLrC//Ci� LOT NO.�14
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z������ (IT'Y OP CUPERTINO p
f 'I I Sanitar No. S—ZZ
2 2 '967
3 a Uat 1967 Permit No ����ia •7 /
w LL _ Pee $ oZG
10 1/ !lam /ll l f1
e'pplicatimr)s hSedPET1Tto`�the City of Cupertino for a permit to install plumbing
W pipes and/or
'o fixtures listed on tli 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 w Cupertino, and all oche laws applicable thereto.
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0 o Use of Premises
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a a J�G..S�7/� Approved ._ ..
1 < o State License
`Y - V PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
7
Size 14
Water Closet
Material GV
Bath Tub
/
To Curb
Shower
/
To Prop. Line ✓
Lavatories
To Existing
-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 & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee V
Area Drain
Main Drain Fee ,
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
jjJ
Total Fee