51187C 72a �� j LOT NO.
NO. S EE.T
APPLICATION FOR PLUMBING PERMIT
5S7\ CITY OF CUPSanitar
OERTINO
�S J 3 c3 f=
Dlt'" ( CIS N t ' 196e Permit No.
� APR 9 196 Fees
Application is hereby made to the City of Cupertino for a permit to install Plumbing
ai o �xtur>s� �4 Ch reverse side hereof, and agrees to install said rices
n�d�or ixtiues ir�ac�Lirde wit the provisions of the Plumbing Code of the City of
Cupertino, and all other—laws applicable thereto.
Use of Premises
/J Way r
Owns ���✓/�( n Address
CONTRACTOR, AGENT
Phone 4a5&— .2• �d 3
State License
WILLIPS.1 D.
PLUMBING INSPECTOR C�
FIXTURES NUMBER —MAIN DRAIN
UNITS FEES UNITS t'EES
:r Ifeater A I I a I
Closet
Shower I / 1 11 To Pron. Line I -� I I
Kitchen Sink
Dish Washer
Machine
Comb.Sink & Tray I 1 II To Curb
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader -
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee oZ6Q
Total /
Total Fee �. SD