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NO STREET
rAPPLICAI01p [f OR PLUMBING PERMIT
AID?
h 0 Or CUPERTINO
AID 15 1968 1660 � L1 6 Sanitary No.
Date 196E Permit No
�.�..tr ` �- u`jOI �Fee S o%3 S d
Application is hereby made to the 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, and all other laws applicable thereto.
Use of PremisesLZ-
�• `�
/tJ�
Owner '�L Address- - L��4� G �
,:f li u �7 � .F1c•C�
By. E - Address—S�,r.��w l�i�cti L�w�
/CONTAACS. AGENT
Phone 'L S e) 4 C/
State License a
PLUMBING INSPECTOR /
< V
FIXTURES NUMBER MAIN DRAIN
UNITS1 FEES 11 UNITS F ES
Water Renter Size fO
Water Closet /s. 7 _
Shower
11
To Prop. Line
Lavatories
3 "'11
To Existing
Kitchen Sink
/ /rU
Not Conn.
Dish Washer
/ —
Sewer Box
Waste Disposal
-v
Wash Tray
STORM DRAINAGE
Washing Machine
4 s-�
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
flapper
Size N ,So
Restaurant Sink
Material 6a d.
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee 13 S-✓
Area Drain
Main Thain Fee J5 ell
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee 3 `'
Relief Valve
Gas Fee s�
Vac Breaker
Skimmer
Filter
Permit Fee
Total
/ S d
Total Fee 3 v