Plumbing Permit LOT NO. /
NO. SnEE.T
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� I3',R PLUMBING PERMIT
z < irr�i ``��''RCUPERTINO
r 0 SEP 9 1968 Sanitary \0.
K LL
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a Date 196— Permit No
3
U (��T�/ (� (�I'p[p Inln 0
a t�4bd W� �1}311� 6��H tLlfy Fee 5 O
° Appl i is reb} 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
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all otherlawsapplicable thereto.
j LL - Use of Premises
00
0
3 Owner
z By �1"�C Address—SS^/� 7
0 CONTRACTOR,
AGENT
3 `m Phone— -^G � 7
a 0
u State Licens/e 15J3 fO Approve
_U 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 Rain
Comb.Sink&Tray To Curb
Dental Unit
-
Drinkin Fountain
Floor Rain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Rain Main Rain Fee
Water Leader Storm Rain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Iter
AW
Permit Fee
Total Total Fee jr4scee