NO PERMIT NUMBER (3) �n/�-✓ I " L) LOT NO.v
NO. T 57WtET
® 'I 4. MR PLUMBING PERMIT
CUPERTINO
x o f0 T 24 1961 sanitary ren.
LL
3 a Date Permit No
2 LL
CITY OF CUP�R��� Fee S 2 X
° Application is hereby ma e o t 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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other lacus applicable,thereto.
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f r
LL Use of Premises
0 0 �S7l�f�
Address
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z By ///�xi /���l�f��1// Address—
CONTRACTOR,
ddress CONTRACTOR,AGENT
3 m Phone .17 f � ?
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1W 1+1II7—LIAM D. 6ENTEv;C t
u\ 0 State License 's�� Approved 1/a U PLUMBINd INSPECTOR Ci
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet .Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink t 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
Area Drain Main Drain Fee 02l
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee /,rl/
Relief Valve as Fee /.
Vac Breaker
Skimmer
Filter
Permit Fee o2.O-t/
Total / '� Total Fee