51140 �F 2C6-12- 1 L t,,*x 06000i^/:.0 l• " LOT NO.
NO. STREF.I'
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPE•RTINO
ro 16 Sanitary__ Sanitary Nu.
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0 a Date - Y Permit No
3 �NOV tG 1967 Pees 3 '—
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
ai es and or fi s ��pprr�{{��gtt�g�'rse side hereof, and agrees to install said rices
nd/or +r4�fesacci"c[RCfUdtN6lprovisions of the Plumbing Code of the aty of
i w Cupertino, and all other laws applicable thereto
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n Use of Premises w�.� / y-"`'� JV�•L A�i'�
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r 3 Owner y -f— pt_�+ Address -?o(�5�7. z,e..
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, By Address
O CONTRACTOR, AGENT
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Approved
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-�L 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 Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.SinkBTray To Curb
Dental Unit
Drinkin Fountain-
Floor Drain WATER SYSTEM
Flo per Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
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