51183 PLUMBINGIr �A7"ISATICM FOR PLUMBING PERMIT
/ UV 2$ OP CUPERTINO
1968 Sanitary No.
UaM m 196j?Permit No ,$ // �3
lel PERTINO Fee $ a 41G S�
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 in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other lawsapplicable
� cable thereto.
Use of PI �!remises a r ^/L'G 1 v a f' �/L
f' ���A
Owner
�_[__/fie r/�b/ ,e
By //d-•O/i1 `CO. IdX -* �t
c� CONTRACTOR, AGENT
Phone �yq-11�i46
State License /9�/ 7 O
Address /,
Address )0018 O x �iS
SdK.tOXC
WILLIAM D. ^ZNZ/ICH
PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS
FEES
Water Heater
Size
Water Closet
001 Material TO
Bath Tub
'1'o Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
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
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /
ro
Relief Valve
Gas Fee
.fid
Vac Breaker
Skimmer
Filter
Permit Fee o2
'L -
Total
Total Fee oZ
5 -a