100147 /D 0 I IE.T S G I LOT NO.
NO. STRF.
w < l� PPIAATION OR PLUMBING PERMIT
��JJ CITY OF CUPGRTINO
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7 Sanitary No.
o Date J, 196 9v Permit No 6o d1
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o tJApplicati0 i rh�'Ry deNtothe ity of Cupertino for ermlt to install plumbing
'o r pipes and/or fixtures listed on th verse i • reof, ree t install said PILO
> r and/or fixtures in acc� an f t
a w Cupertino, and all e laws ,l rca eethereto.-- -- --
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a o State License Approve
_U r l <e' 703 PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater Siz _
Water Closet M e al
Bath Tub o
01
Shower o ro ine
Lavatories
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
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee