51046 10-71 CG I /?ee LOT NO.
NO. STREET
seAPPLIATION FOR PLUMBING PERMIT
.V OF CUPERTINO
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E o I Sanitary No. X1-3X1-37 3
o ' bate VsEP g 1967 t 196_ Permit No
3a
1 LL
Pee $ 7"
' 0 A�;;pljcatiopnjis hCreIF eTPihe City of Cupertino for a permit to install plumbing
o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
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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LL Use of Premises
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3 OwnerA6y'Q� "�/L F Address
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z By f �A/r D ��'f• Address
3 O CONTRACTOR, AGENT
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a o State License. Approved
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(-) PLUMBING INSPECTOR v
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Fleater Sine
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 Main Drain Fee
Water Leader Stam Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fec
Vac Breaker
Skimmer
Filter
Permit Fee Ye
Total LTotal Fee 7c 0