NO PERMIT NUMBER (3) /D I '1E_V &L FL LOT NO.
NO. ,
/j rAPPLICAT�ION FOR PLUMBING PERMIT
CITY OF CUPERTINO
ro \. 'AUG 1 1068 Sanitary No.
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0 < Date 19L Permit No
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Fee S a 9• s
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r Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes 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
a w Cupertino, and all other laws applicable thereto.
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�. Use of Premises
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oa Owner A Address
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= O By CONTRACTOR, AGENT 625harMd3ff6e'
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— 0 Phone San Jose, California 9511
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a 7 /� pp WILLIAM U.
3, bcr�EVICi1
1 u o State License 17AS -/ Approved
�,�U f PLUMBING INSPECTOR
FIXTURES NUMBER P MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater7--j-41- Size 4,7 r 4v
Water Closet U,I"7J Material C 7-
Bath
Bath Tub d7J To Curb
Shower w To Prop. Line
Lavatories el- r, d-V To Existing
Kitchen Sink rfj Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray S'rORM DRAINAGE
—
Washing Machine /, p Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size I "
Restaurant Sink Material .¢L�/ /,J-a
Sand Trap TOTA1, FEES
Urinal Fixture Fee y. O
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fec
Relief Valve I Gas Fee , J'j
Vac Breaker
Skimmer
Filter
Permit Fee
Rta—
Total
/ /% 1� Total Fee