51193.1P�(� �fY 9 .� /T'7�s-.,.'+-c. ] LOT NO.
NO. STAF.F.I'
,APPLICATION FOR PLUMBING PERMIT
VD,
ITY OF CUPERTINO
Sanitary No. &/63Date _ _ _ '� 196E Permit No '`l 93 -
Pee S
-Application is11i reby,mai elto the City of Cupertino for a permit to install plumbing
pipes and/;r fixtures_lgtec�lon�dle 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
Cupertino, and all other laws applicable thereto.
Use of Pre ises - - p—
Own
13y CONTRACTOR, AGENT
Phone
State License.
Addresso,2
Address 't -e
Approved
PLUMBING INSPE O
FIXTURES I NUMBER MAIN DRAIN
UNITS FEES UNITS I FEES
Water Closet 1 3 1 *.5 -� II mtere ; 1 1 1
To
Lavatories
Kitchen §ink
Dish Washer
Machine
Comb.SinkBTray I 1 11 To Curb
Floor Drain Ej A'ATER SYSTEM
Hopper Size P, I
AL FEES
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee 3 Cd>
Vac Breaker
Skimmer
_
Filter
Permitl'ee •�
Total