NO PERMIT NUMBER 1 3y i LJIH eArok m e. LOT NO. 1:5
NO. ST E.r.T
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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x o Sanitary No
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3 a Date ' 196 Permit No
Pee $ vv
2 LL
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o Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed on the revers de an agrees to install said prices
> and/or fixtures in accordance with theFf
i ot. t Pn Cnde of the City of
a w Cupertino, and all odt alws applica Use of Premi "-� SEP
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1- 3 Owner �ddress1
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By CP.:t�,ar �.,A�dres'sPE RTINn
4 courencroR,AC'26 Charles Street
- 0 Phoned-9 San Jose. California 9512
w i
u °s State License 17 YS 3 2 Approved
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4 U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size z' 1O
Water Closet ,DO Material iL
Bath Tub / To Curb
Shower / /.,SO To Prop. Line
Lavatories ,3 „SP To Existin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine ,$Q Size
Water Softener Material
Bar Sink To Ma' ain
Comb.Sink&Tray urb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size J, ,c�
Restaurant Sink Material G'9,cd
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee p
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total .DO Total Fee ad