51113 vo:j C�^2 'a-y") LOT NO.
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APPLICATION. FOR PLUMBING PERMIT
z a �, �AUU 1 j 1968 LJ.' CITY OF CUPERTINO
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r o Sanitary No.
Q 4
o a .Tate - --� - 114
196 Permit Nos
y I � Fee $ r
1.
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O Application is hereby made to the Cily 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
> 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.
LL Use of Premises -r-LA' �-CC.,2u� t
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3 Ownep //CA �v-a_P� Address/D 3/7 (.. �✓4?L/�
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CONTRACTOR, AGENT Q - i
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a ao9aao Approved WILLIAM D. BF_NEVICH
u Y State License
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—U PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Wa[er Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink 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 WA'T'ER SYS'T'EM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee Q O
Area Train Main Drain Fee
Water Leader Stonn Train Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker V .d
Skimmer
Filter /
Permit Fee d0
Total Total Fee 00