51179 (2)C U„ X13 I 11-'d "- Z /z / LOT NO.
NO. \ SS�E]',,
N j ��APPLICATI�OjN. FOR PLUMBING PERMIT
.z d t d1TY OF CUPERTINO
x o : mAR N 9 1568 Sanitary No.
0
3 < Date �-' 196-r Permit No J -//7
Fee S
O Application is hereby made 'to the City of Cupertino for a permit to install plumbing
o r pipes and/or fixtures 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
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Cupertino, and all other laws . )plicable thereto.
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LL Use of Premises 01A/ e
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0 3 Owner // r_ Address /�
z By �lQ' P./ -fU n' eY Address ¢
J C) CONTRACTOR, AGENT
- am Phone
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u State Liens�/ ? APP
rove
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- PLUMBING INSPECTOR /
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNPI'S FEES
Nater Heater
Size
Nater Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Hasher
Sewer Box
Waste Disposal
Comb.Sink R Tray I 1 II 'I'a Curb I
Floor Drain I I II WATER SYSTEM
TOTAL FEES
Water Leader I II Storm Drain Fee I
Sprinkler Valve {Voter Sy
s. Fee
Vac Breaker
Permit Fee
Total Total Fee