51070 161 / I LOT NO.
NO. STREET'
N ,A PP0C-ATION FOR PLUMBING PERMIT
z 6ITY OF., CUPERTINO
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W M �l � y No.Sanitary SAP 1°68 ( O .
o < Date �� 1968 Permit No
3U Eee $ x;7. 00
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Application is hereby'made'to ti6City-of Cupertino for a permit to install plumbing
`oP ipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
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Use of Premises C061-4' A—'��
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r3 Owner �o��iz �/—'+ =( dress
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o By ( fZ srL�i��1li.���� t Addr l� 66(Ae/�a
3 r CONTRACTOR, AGENT
Phone— 1
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a o State License 7�S .3 Appr
O PLUMBING INSPECTOR I�
FIXTURES NUMBER MAIN DRAIN
UNITS FEESUNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories •Q To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash TraySTORM DRAINAGE
WashingMachine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
DrinkingFountain ,s
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
UrinalFixture Fee .S
Area Drain Main Drain Fee ,S,
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys. Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee a DQ
Total I / $ Total Fee .3-2—dr,