51001.3 (2) /D I / �'�✓ /�.�./vi/ OT NO. G
NO. 5 EE.T � � _ 1
r' 6I 1 t FOR PLUMBING PERMIT
z i ® OF CUPERTINO
x (JUL 2 1968 Sanitary No. S."�
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o a Date 196— Permit No. 's C
3 s9
wLL CITY OF QPERTINO Fee •sem
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� Application is here y 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
> 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.
a Use of Premises
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3 Owner Address
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z By Address � yo c 5 V( 'W'e
OCONTRA(. R, AGE
3 F
Phone � z
. z _ �:7
State License K CL �_i r� Approved y
a 0
- 0 PLUMBING INSPECTOR
X
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
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink R 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 Stem Drain Fee
S rinkler Valve Water Sys.Fee
Relief Valve / Gus Fee
Vac Breaker /
Skimmer /
Filter /
Permit Fee W
Total a_ 11 Total Fee S�