100167 10 01 I IV .5A,�07o.6A— <;VA/41/61/�
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
i j ' ' CITY OF CUPERTINO /G 3F.21r � ', i SEP 19 sanitary Nn.
0 Date /o v � � 7
0 < Date 196 Permit No.
3 Pee $ l0 sSZl
r O A'pplicdtion'is hereb}'tinade to•the'City of Cupertino for a permit-to install plumbing
o 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 tither laws applicable thereto.
Use of Premises
00 �-- � 7
3 Owner,Cl�r�it/ck�s$11/ Address
oa
z Byrr—k-roQr. SGp✓^ %alr. Addre4-JI (gU-_'7_—sUS
CONTRACTOR, AGENT
3 �
.
ao State License 7��3� Approved /
-U PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Beater 30D Size U I`
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories 119-,O 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 g
Sand Trap TOTAK FEES
Urinal Fixture Fee ,5.00
Area Drain Main Drain Fee ,ter.
Water Leader Stone Drain Fee
Sprinkler Valve Waters s.Fee is
Relief Valve Gas 1'ee 8w ,
Vac Breaker
Skimmer
Filter
Permit Fee • �D
Total n .9 Total Fee