51075.3 (3) Io 1 0 0 I2c, 0..—* / LOT NO.
NO. ET
® I R PLUMBING PERMIT
d . T CUPERTINO
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E g . ,OCT 24 1967 sanitary No.
Y LL
o Uate October 17 196— Permit No 7s .;'
3a
= 4
CITY OF CUPER I Fee $ 13.00
0 Application is hereby made to hc'L7ty of Cupertino for a permit to install plumbing
o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 1- 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.
Use of Premises �t�.t./
00
' "
0 3 Owner Intersil Address
oz 8 Viking Automatic Sprinkler Address251 Shaw Rd. S.S.F.
J O y CONTRACTOR, AGENT
3N Phone 583-3441
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Qa C16-187293
Qutate License Approve
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 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
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink \laterial
Sand Trap TOTAL FEES
Urinal Fixture Fee _
Area Drain Main Drain Fee _
Water Leader Stomp Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
�7tiw
W n
Permit Fee 12
Total Ij Total Fee