100169 106 .S bL rA W 4, LOT NO.
NO. STREET
n�" P r'IC%'TJON FOR PLUMBING PERMIT
ITY OF CUPERTINO
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2� 1968 Sanitary \o,
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° a Date 196— Permit No.
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Clzpp,i ton e a e o the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to inst said prices
> . and; fixtures in accor nce with the provision of the Plumbing Code o the City of
a m Cupertino, and er \ 1 lic ble theret ( _
Use of Premises 0 pC ` e �w
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< 0 PLUMBING IN PECTOR{/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNrrs FEES
Water Heater Size
Water Closet S"t' Material
Bath Tub To Curb
Shower J" 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 , 7-0
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee Q6