51113 LOT NO.
NO. STREET
I1 FOR PLUMBING PERMIT
D v O CUP UMBI
MBI
wTINO�
" n Qtwk- Sanitary Co.
o aDaPermit No.
3 .81ER�1N� i
Pee $
' o
� Ap Ali n terbA�made to the City of Crupertino for a permit to install plumbing
0 pipes6c i r Lures listed on the reverse side hereof, and agrees to install said prices
a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, andall other r s applicable thereto.
w x
� r
a Use of Premises
00 �^ n /�6 �9
3 Owner I /Yl C �7 D /\ Address a }f1a a�
g Vy�iN PLJMBING CO.
z By?�?S g r,ai��r�l celcl n ane n Addres
O ONTRAC OB, A T
3 < Phon REDWOOD CITY, CALIF. 365-0714
w n 9-1 -70
a o State Licensee/ S S Approved
— PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units I Fees I Units ees
Water Heater Size / D
Water Closet I Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories A161 To Existing
Kitchen ink N Not Conn
Dish Washer lip 7
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
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Re]6ef Valve 11 Gn,Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permi[Fee
Total Total Fee "._}C