51167.1 Plumbing PermitU Q
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LOT NO. /U
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO _
Sanitary V'u.
Dat �J 19 (Z Permit No _5 / / V %, /
U6 1 1967 `- Fee $ h2
Ap[lication is hereby made to the City of Cupertino for a permit to install plumbing
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/ Ext
�Pt$ a qr� �t t reverse side hereof, and agrees to install said rices
and/ J fixTA in�1F�8A "kit'i)tile provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises! `
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Owned- 1-1�41-11./l Address
By . �i lifer. t/ Address
CO TRACTOR, AGENT
F�2
State License fr%s"7z
Approved
PLUMBING INSPECTOR
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FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Hester
Size
Water Closet
L5
Material
Bath Tub
To Curb
Shower
/
To Prop. Line v
Lavatories
9
To Existing
Kitchen Sink
/
Not Conn.
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
Floor Drain WATER SYSTEM
Hopper Size I
TOTAL I
Fixture Fee
Main Drain Fee
Storm Drain Fee
Permit Fee
Total Fee