510411 LOT NO. /
NO.
10N FOR PLUMBING PERMIT
" Q
CITY,OF CUPERTINO
fJUL 22 1968
z p Sanitary No.
Q 4 /0 ' Date 196— Permit No
ir.!7V 17 L13 )rnYi ro Pee $
° 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
<w Cupertino, and all other laws applicable thereto. ,
Use Of Premises
OO 0
' " 4r co SA Al iA CL�tR�
r 3 Owner�lL�- Address
oa
*J <, Sc A T A
* z By I I L7 A)C , Address
° CONTRACTOR-, 'EI�p pp
3N Phone 36 C1 �C.3.5� `� KeDwoop C1
'tate License / r � 371 Approved
PLUMBING INSPECTOR
FIXTURES NUMBER 11 MAIN DRAIN
UNrFSj FEES I 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&TMY To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee V
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker Q
Ski
F' e
Permit Fee 160
Total Total Fee