51001.2 LOT NO.
NO. STREF,I'
APPLICATION FOR PLUMBING PERMIT
" < CITY OF CUPERTINO
0 In lr NU.
LL
0 < Date Ij 1 6_ "� Ber id t�No � Z
3U OCT 1. 1968 Lt . 'Fee
I n tYY- Jy
' 0 Application is hereby made to the City of upertmo for a permit to install plumbing
'o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
'z in
and/ fixtures in accordancrfwithftheyrr0v isions)ofltJte Plyrpbing Code of the City of
< w Cupertino, and all other laNN plicable -----clot 1-1
Use of Premises -
0 0 _
o a O Address//&<
ZJ
z By Address -
O 3CONTRACTOR, AG T`m Phone d93- Qt/07-7
a WILLIAM D. CENIZ-VICF{
O Y State License. / 3 Approved
{ a o /
�t —U ! PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEESoNI S FEES
Water Heater Size
Water Closet Material °
Bath 'rub 7 To Curb
Shower a To Prop. Line ✓
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
W'ashin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain NATE SYSTEM
Hopper Size % v
Restaurant Sink Materi. ,C
Sand Trap TOTAL FI F
Urinal Fixture Fee 19 .J
Area Drain Main Brain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 9 —
Total Total Fee