511813
No. Street Lot No.
Date
IvPP -1 BI ���jjj t�FRMI7
r OF CU �R I Nl
OCT 14 1968 nitmy No.
196 _ Permit No .';F;X/
CITY OF CUPERTINO Fee $ //-
is hereby made to the City of Cupertino for a permit to install plumbing pipes
in accordance with the provisions of the
laws applicable thereto. _
Use of
of the City of Cupertino, and all other
Contractor, Agent
Phone L-il
State License
Address /ter— g
WILLIAM D. DENCVICF
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
To Existing
Kitchen Sink
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 S"a
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve,
Gas Fee SZ
Vac Breaker
Skimmer
Filter
Permit Fee el. Pe
Total
.�
Total Fee o -v