51167.2LOT NO. -2//
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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zd p CITY OF CUPERTINO
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i o ® 2' Sanitary No. `� 0
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j •hJ. tef ll I July 196-8 Permit No
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m 1 b8 Fee $ a L
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� Abp tion is hereby made to the City of Cupertino for a permit to install plumbing
o pipes anj/orj%Qres listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures I& !a t rdance with the provisions of the Plumbing Code of the (:try of
a w Cupertino, and all other laws applicable thereto.
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a Use of Premises
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3 Owner Dits Craws CompazW- 2AiYd(es3e La Cras-Boulevard
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j, By Palm Plumbing Compal ,qju �yvale�aratoaa Road
O CONTRACTOR,AGENT
32115-2323
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u, f State License 186579 Approved /
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PLUMBING INSPECTOR /
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FIXTURES
DRAIN
UNITS FEES
Water Heater
eWater
ClosetterialBath
Tub
CurbShower
Pro . LineLavatoriesExistinKitchen
ink
TNUMBFRM.AINMAIN
t Conn.Dish
Washerer
BoxWaste
Dis osal
Wash TraSTORM
DRAINAGE
Washin MachineeWater
SoftenerterialBar
SinkMain
DrainComb.Sink&TraCurb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee 3'
Water Leader
Storm D m Fee
rinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
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Total Fee �j