51115 No. Street Lot No.
o —
N
a„� C
UAPPLE AT P IT
E
OCT 31 1968sani _No.
"c Oct✓
c Date O 3v , 196 Permit No
ii
CITY OF CUPERTINO �
° Fee S
0
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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
c laws applicable thereto.
A o
/r/y ;, Use of Premises � f Sy�t i�- r.c r
4.
° Owner S'o �- Address sA� / .as s�o�.n
a
By Address
3 Contractor,Agent
° Phone
E=N2VICH
State License Approved
�F Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories TQ Existing
Kitchen in Not Conn,
Dish Washer
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
Water Leader Stom Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Gag Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee