51046 (2) /,0/"/ ' ' U/�/IO✓J LOT NO.
NO. STR RF.I'
APPSnE tON FOR PLUMBING PERMIT
z ¢ k1 CUPERTINO
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0 ff ��V 2�, I �7 Sanitary No.
o j Date YY 1961 Permit No Fee
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1 LL O Apl&LIT oinrehytn%
TtlVh'0ty 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
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
in
Cupertino,Cupertino, and all other laws applicable thereto. -
LL Use of Premises
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3 Owner—F—,J � P4 0ZVZ ��il� Address/Og-7 /-,VDOI�
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By RAYNE SOFT 1AIATFR CFRVICE�+ddress
CONTRACTQR, AGENT.
— m Phone SANTA MAGA eAIIMD 'n ngn
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a PHONE 241-3370
u s State License Approved WILLIAM D. 6Z—NEV1.^.H
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��—U PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material _
Bath Tub To Curb
Shower To Prop. Line
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 Main Drain
Comb.Sink&Tray To Curb
Dental Unit'
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain I Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee