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%% APPLICATION FOR PLUMBING PERMIT
1V 'CITY OF CUPERTINO
OV 27 1968
/ya ✓, /%t -t ; ; r%
Late _ . __
Sanitary i\'o. n
Permit No
Pee $ -99, 049
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner �C' T' -�/ �O�S.� %� Address%7• i✓'�� Tf=/[ 09
Address �i S- c4eAtze�y
CONTRACTOR,AGENT SzyN va r"
Phone 7"y f 0�6
State License. 417/f3 % Approved_;
/ PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS
FEES
UNITS FEES
Water heater
Water Softener
/-.J
Size /+1 ' I / ,/•.00
Water Closet
Comb.Sink & Tray
. IT
Material C7 .
Bath Tub
Drinking Fountain
,f-,�,
To Curb
Shower
Hopper
_�.�
To Prou. Line
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size % I / TJ
Restaurant Sink
Material dry L
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee f•�
Water Leader
Storm Drain Fee
Sprinkler Valve
Waters.Fee • 1'0
Relief Valve
Gas Fee /• y
Vac
1 11 Permit Fee o�
Total i 7x P'00 11 Total Fee O 0