NO PERMIT NUMBER c No. Street Lot No.
0
APPLICATION FOP-PLUMBING PERMIT
"CITY OF'.CUPER"IiIN
0
�SanitNo.
t
C 1
Date 1196—OCT 9 1968 PermitNo.
1.
3Fee $ QO
Application is hereby made trtrYCity of Cupeitinolfor-a permit to install plumbing pipes
-,- --and/or fixtures-listed-on-the-reverse-side-hereof;-and-agrees-to-Insall-said-prices.and/or_fixtures_-_
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
.G laws applicable thereto.
ro o
ro m Use of Premises
048 -4 Mgt t00%—
o_ v
o OwAMAMPS WV, MW Address
By IC Address
3 Contractor,Agent
� Phone
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IL
State License Approved
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 J aft
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
P
Permit Fee �b
Total/Yl Total Fee 0