51167.1[ /�Ir/.�1�1'LY/LCQ/ �.LC� LOT NO. 'fD
NO. STRFF.T
APP,LICATION FOR PLUMBING PERMIT
i=� LIT,Y OF CUPERTINO
W, Sanitary Nu.
s�� erg
r i� 2 1967 r
o Date 1967 Permit No
3`
Pee $ z2- :f d
Application 4s hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> a 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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3 Owne - / �L -f Address
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By �.r3sL i
z Address
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CONTRACTOR, AGENT
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Phone ?5�5�-'P 9-5
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w w/ `-�L p WiLUAM D. r-�V^ =-z
s State License zzYApproved
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1'1P
-0 PLUMBING INSPECTOR
_FIXTURES
NUMBER
Water Leader
Storm Drain Fee
UNITS FEES
Water S s. Fee
Nater Heater
/
Size
Water Closet
Skimmer
Mater
Bath Tub
Z
To Cr
Shower
/
To Pr
Lavatories
To Ea
Kitchen Sink
Total
Not C
Dish Washer
Sewer
MAIN DRAIN
UNITS FEES
b
a.
STORM
ze
Comb.Sink&Tray � 1 11 To Curb
zIh nkin Pountaun
Floor Drain WATER SYSTEM
Hopper Size I A
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water S s. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee .1 ere
Total
11Total Fee I„'�lj�