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AP?L�ICAYiIO', FOR PLUMBING PERMIT
d E �itlM'Y'!CF CUPE:RTINO
r ° IJUL 2 1965 Sanitary No.
11
3 a.-// ('i �_
° � Date nn 19/6�— Permit No
W W ('11Y l r �;il?ERT{ 'tl FeeS Jet'
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Appli6tion is hereby made 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
z w Cupertino, and all other laws app cable thereto.
w 2
LL Use of Premises
00
'x (Ye ra l G� ( / Ctr- Address t�
3 Owner
oa
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z By Address
° CONTRACTOR,AGENT
a ��5'�—��7'7
— z Phone
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ao State License Approved
- U PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen §ink
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
_
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
I Gas Fee
I Total I 1 11 Total Fee