51046 (2) / T I LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO F'
zi
Sanitary No,
0 < Date — 6— Permit No,
3� 1SEP 12 1967 ; Fee s7s s=
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes ((ppr re i��tedr�oDnTtih;e reverse side hereof, and agrees to install said prices
i a and of�hxtur in a �Yi"Y�F1TTrI ',& provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws app icable thereto.
a Use of Premises
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� 3 Owner —w9/,7 -/
ca -11 Address✓&30 �A fR£NQA LUr
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By iNC r-- F u/h 1/1 rtddress / V /9FLL Avf
OCONTRA O , AGENT
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a C ��� 2 (F� WILLIAM D. 3CNSVICX
a o State License Approved /
'� —0 PLUMBING INSPECTOR (/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Waterleater Size
Water Closet Material
Bath 'rub 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
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee _
Water Leader Stoma Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker _
Skimmer
Filter
Perniit Fee
Total Total Fee