51027.7 (4) 9 6 � I I7r �a LOT NO,
N PL EFT IS� �1Y U �G PERMIT
z d .ITY OF CUPER
mrc OCT 15 1968 iry \'u.
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Y
3 U Date UI 1969 Permit No. /o-,t
w= , CITY OF CUPERTINO Fee $
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� Application 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
a Cupertino, and all other laws applicable thereto.
0 4 Use of Premises f
00 �C s
oa Owner` - ,/OI.�u_�!�?'�^d!�� Address �� 6 7�//I?-",�'✓tle(
zBy �` Address G G yam-
O CONTRACTOR AGENT I
3 0 Phone
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WILLIAM D, z _,;ZVICH
U Y State License—;-SJ Approved
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNrrS FEES
Water Heater I Size
Water Closet Material
Bath Tub To Curb
Shower To Prep. Line
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer I Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tmy kWATER
urb
Dental Unit
Drinkin Fountain
Floor Drain SYSTEM
Hopper Restaurant Sink ial
Sand Trap TOTAL FEES
Urinal Fixture Fee 'L
Area Drain Main Drain Fee
Water Leader Stomp Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
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Permit Fee
Total Total Fee uv