51046 1-667 61 , X / — LOT NO.
NO. STREET'
o r\PPtIC TION FOR PLUMBING PERMIT
WITY OF CUPERTINO
SanitaryNo.
zi
° I (SEP 8 1967
3 a 1. ite 196— Permit No
u Fee $ 7�
° CITApphfilton �iQ��� the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures isted on the reverse side hereof, and agrees to install said prices
r 1- 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.
w x
Use of Premises
00
> 0 p L!/n�.�
3 Owner Ot���1Kp Address
ZJ 4� 'n
z By1'e9iab Z!< a='• Address/YD6
O CONTRACTOR, AGENT
– `0 Phone
w z
a WILLIAM D. SENEVICH
0 a State License Approved
—(1j l
PLUMBING INSPECTOR /
a
FIXTURES NUMBER MAIN DRAIN
UNITS kjEES UNITS FFES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower 'I'o 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
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TO'T'AL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 2'r'
Total Total Fee ? 6 .