51001.4 ;1 aj &4 14AN LOT NO. I I I
No. $ �V\
��APPLICAT ON FOR PLUMBING PERMIT
w d CITY F CUPERTINO
rf UL ���� =OSanitary No.
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o Date a3 196S Permit N
3� I— n...)rry ij f
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� Application is hereby made to the City 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.
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Use of Premises -�+��--�-r' 4
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3 0wne171)le e/F/v& rV /)i 7.V 00/Ckddress Sf2'/!/I- 01-V'7A'�
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o By (2'2 e S/a+ irN l0//-S ( Address S.91tl 7PSC
3 F CONTRACTOR, AGENT
i`n hone '�93-�d77
- U 'tate License �•� 9 3 Approved
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 Di osal
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 0.J
Area Drain Main Drain Fee 0 o
Water Leader Sturn Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee .�'y.