NO PERMIT NUMBER (3) /D�6 q IV E D RL L LOT NO. 3
NO. STREET
cAPPLICATIOWFOR PLUMBING PERMIT
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z a / "COF CUPERTINO
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r o I AUG r,� ���'$ Sanitary No.
0 a Date �, 196 g Permit No
Fee S0 0
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
`or 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
<w Cupertino, and all other laws applicable thereto.
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n Use of Premises E.f
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r 3 Owner C' 7' L IUD3 AY Address
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By C"d)kat SAMkq CO., 9irc.
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CONTRACTOR, AGENT 625 Charles Street
- 0 Phones 0 SSG 4an lose, California 95112
w w WILLIAM D. SENEVICH
R d 7 1 5 3 7
a o 1 Stale License_ Approved
—U PLUMBING INSPECTOR
FIXTURES NUMBER k)D MAIN DRAIN
UNITS FEES I UNITS FEES
Water Heater / I Size
Water Closet 3 Material
Bath Tub / / J-0 To Curb
Shower / A J V To Prop. Line
Lavatories 4el d° To Existing
Kitchen Sink / da 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 C6
Dental Unit
Drinking Fountain
Floor Drain WA'T'ER SYSTEM
Hopper Size / "
Restaurant Sink Material b4-LV I o
Sand Trap TOTAL FEES
Urinal Fixture Fee /
Area Drain Main Drain Fee f w
Water Leader Storm Drain Fee
S rinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �—
Total /f - Total Fee