51125 J
I�„JG'��„�"„'C LOT NO.
NO. i STREET
N rAP„PLICATION FOR PLUMBING PERMIT
< ON CUPERTINO
_ Sanitary No._ f - _ 3
0 < Dat lill 04 1967 -r,gV96— Permit No
3 LL Cee $
� o
A 1 ioid hgrc�sp�a(1 tprttlF($City of Cupertino for a permit to install plumbing
'o � pipet' v �rl�lll� tur g t everse 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
Ln
Cupertino, and all other 's applicable thereto.
Use of Premises
00
3 Owner .-. Address
OJ
z By �� Addresq
CONTRACTOR, AGENT
Phone
z
'tare License Approved
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Water HeaterSize C
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existin
Kitchen Sink V
Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin 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 pro
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee r
Vac Breaker
Skimmer
Filter
Permi[ Fee
Total Y9 7TWTotal Fee Q