NO PERMIT NUMBER �986� G)�ERto� Y/L LOT NO. ✓v
NO. STREET
APPLICATION FOR PLUMBING PERMIT
" < CITY OF CUPERTINO
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Y Sanitary No.
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0 a Date b/ 196-8Permit No
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Pee $ 7
0 Application is hereby made to th Ci^wt
' or a permit to install plumbing
'o pipes and/or fixtures listed on �fjr en rees to install said prices
and/or fixtures in accordance wit}✓ eP Ing Code of the City of
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Cupertino, and all other laws l s hereto.
r S 19 1968
LL Use of Premises .i
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3 Owner�_.I�� 1�f1�yS�5FUY ens rr C�J'�r
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By C (ess
= O CONTRACTOR, AGENT 2b Lonat":
3California 95112
— 0 Phone';q?—'0S-S1V San Jose,
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a o State'License l w�3/ �7 Approved _ -
1, — 0 >11 PLUMBING INSPECTOR t:�
td&FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size 411
Water Closet o Material G.
Bath Tub —D To Curb
Shower -0 To Prop. Line
Lavatories 34,cm To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine /15,91 Size
Water Softener Material
Bar Sink To Main Drai
Comb.Sink&Tray To Cur
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size J' I
Restaurant Sink Material G,41,11 1
Sand Trap TO'T'AL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee b
Vac Breaker
Skimmer
Filler
Permit Fee
Total O S OO Total 17__
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