NO PERMIT NUMBER �7 I ' 1 MAM/ -_��� LOT NO. �I
NO. STPEFa'
APPLICATION FOR PLUMBING PERMIT
< CITY OP CUPERTINO
z
x o Sanitary No.
Q LL
o Date 196 Permit No
W �2 �=
w LL Pee 5
To
Application is hereby made to the f C n a permit to install plumbing
o r pipes and/or fixtures listed on the rr (; n g es to install said prices
i I and/or fixtures in accordance with t Ib rov1stons of�h m Code of the City of
a w Cupertino, and all other laws app lt Ts� t
9 1968
LL Use of
Premisesr —7 S•
00
!'1TY
Owner OF
oa I os
>3y Centhal , 'n.,
zj
0 CONTRACTOR, AGENT 625 Charles Street
3 Phonea"I?OSSG SanJose, California 95112
a o State License/7163 f Approved ,
{� U -<_ PLUMBING INSPECTOR I /
l 1/
U) FIXTURES I NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Ileater Size r°
Water Closet 300 Material C
Bath Tub /• To Curb
Shower / .,0 To Prop. Line ,x
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 M ' ain
Comb.Sink&Tray urb
Dental Unit '
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper _ Size �� �S
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee ZQo
Area Drain Main Drain Fee
Water Leader Storm Drain Fee 60
Sprinkler Valve Water Sys.Fee
Relief Valve as Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total p /SDO Total Fee s O