51122 10271 I Westacre Drive LOT NO.
NO. 1 ' �sTx\T�-
APPL-ICATIbNj FOR PLUMBING PERMIT
z d CITY OF CUPERTINO
I
o _� AipR 168 Sanitary No.
14 4/15/68 .Si/�2
3 � Date I9G— Permit No
4 �il?C�TlI,'fl Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a 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 w Cupertino, and all other laws applicable thereto.
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< Addition
. Use of Premises
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: 3 Owner D. Texera Address1088 Fairfield Ave.
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By W j11CheSteY pl�imhi no ( n_ Address 19 1 7 llal 1 A--%7p_
CONTRACTOR, AGENT
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` 378-7615
— m Phone
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ao State License C 1 0949 Approved /
U PLUMBING INSPECTOR y
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 Drain
Comb.Sink R Trq To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee (J
Area Drain Main Drain Fee
Water Leader Stonn Drain Fee
Sprinkler Valve Water Sys.Fee 5
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 20
Total dooTotal Fee G