NO PERMIT NUMBER. // f1 E4 I I{/ � Vp, LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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z CITY OF CUPERTINO
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W Sanitary No.
ML �f
° a Date V�� 196 4 Permit No
3 LL Fee $ 02 S
� ° Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reversWi
ere ay��ees to install said prices
.> and/or fixtures in accordance with the prmCode of the City of
<w Cupertino, and all other laws applicable
LL Use of Premises EP 1 9 mon
00
> 3
Owner , — 44 MY /,fdtfres e
z By &tZAJ[ Q Af.0 Address
O CONTRACTOR, AGENT IF
3 ` 9' :L
— z Phones" -05
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W WState License. /7��j� Approved
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a U v PLUMBING INSPECTOR
W FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater ..519 Size
Water Closet Z 3,no Material G.
Bath Tub -SD To Curb
Shower / To Prop. Line
Lavatories To Existing
Kitchen Sink / p Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size --
Water Softener Material
Bar Sink To Mai ain
Comb.Sink&Tray 'k-Curb
Dental Unit
Drinking Fountain
Floor Drain I WATER SYSTEM
Hopper Size /"
Restaurant Sink MaterialG'9C.z/
Sand Trap 'TOTAL FEES
Urinal Fixture Fee p
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve as Fee
Vac Breaker
Skimmer
Filter
Permit Fee CA co
Total 5.00 Total Fee $Q0