51181LOT NO.
NO. ST W
APPLICATION FOR PLUMBING PERMIT
C[ OF CUPERTINO
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® C� � Sanitary Nu. 's 3 /-9
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0 a Date 196 Permit No "0�4z
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1 1968 Pee $
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/o�Tix�dlfes� d //�xn� r�c side hereof, and agrees to install said prices
> r- and/or fixtures in accbr anebwiie �r,r � ions of the Plumbing Code of the City of
- a w Cupertino; and all -other laws applicable thereto- -
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Owner
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AGENT
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CONTAAOR,
Phone— Zt d�a D D
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State License
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Address_ �e�Q
Address /' /7 R llti�
PLUMBING INSPECTOR
X
FIXTURES
NUMBER
MAIN DRAIN
UNITS
FEES
UNITS
FEES
Water I1.aater
—/0-11'
Size
"
Water Closet
.3
-3V` Ste'
Material
Bath Tub
To Curb
Shower
/•n
To Prop. Line
Lavatories
745-4)
To Existing
Kitchen Sink
j•
/SSU
Not Conn.
Dish Washer
/
- -
Sewer Box
Waste Disposal
Wash 'Fray
STORM DRAINAGE
Washing Machine
-;-s--7-Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
-
Moor Drain
WATER SYSTEM
Hopper
Size ii
js4)
Restaurant Sink
Material 6,,A• '
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Ori
Water Leader
Stonn Drain Fee
Sprinkler Valve
Water Sys. Fee
o
Relief Valve
Gas Fee
,g'p
Vac Breaker
Skimmer
Filter
Permit Fee
�o
Total
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'Total Fee o