51073 / � G 0 NO.
NO. STA F.F.T
APPLICATION FOR LUMBING PERMIT
" < CITY OF CUPERTINO
s o -�'.`.1 _ t Sanitary \u. ¢'� ( � �•
0 .Tate C— ,'� 1964 o Permit No. �� V7.3
3 �5 '�DEC 31 1968 � Fee s s:3 . so
2 LL
Application is hereby made to the City of Cupertino for a permit to install plumbing
o a ,pipes andfor'fixtures.listed (In the reverse side hereof, and agrees to install said prices
> and% r',fixture'slin accorda_n"cc.,with the provisions of the Plumbing Code of the City,of
a w Cupertino, and all other laws applicable thereto.
LLUse of Premises �' 3
00
r3 Owner— k(11- Address 7 G
0 .o u�-Jrx
z B}y Address —
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< 7W -
0 Phone � 2 �0
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w 22Lf73s
0 Y State License Approved
a yo
—K/ PLUMBING INSP C7
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater Size "
Water Closet Material t0,7,
Bath 'rub To Curb
Shower '1'o Prop. Line r
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 3 Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Thin king Fountain
Floor Thain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee 0 _57V
Area Drain Main Drain Fee S—, 0-v
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee S--b
Vac Breaker
Skimmer
Filter
Permit Fee OZ,
Total '1'0-31 Total Fee