NO PERMIT NUMBER � LOT NO.{'S
NO. STREET
APPLICATION FOR PLUMBING PERMIT
d ,' 6�T.Y)OF CUPERTINO
Ya , `. --- - ^I Sanitary Nu. S. 7 Y-
3 a Date 1_ _ _ 'Q C 7 1962 Permit No
w Fee $ ,-2. ?4-'
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LL W ARlsicgionrls-herebyIvma+,ot the City of Cupertino fora permit to install plumbing
o side hereof, and agrees to install said prices
I 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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Use of Premises
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3 Owne - Address G
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3 o_ CONTRACTOR, AGENT
1A�G�E�1/��� Address
- W Phone
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f State License Approved
Approved .. "
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PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNI S FEES
Water Heater 11 Size
Water Closet a Material lel
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existin
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
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 Storm Drain Fee
Sprinkler Valve Water Sys.Fee -D
Relief Valve I Gas Fee D
Vac Breaker
Skimmer
Filter
Permit Fee IV f9
Total47- .�il 11 Total Fee "j f 0