51167.1 (2)LOT NO.��C'��
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CJTYIOP CUPERTINO
1 Sanitary \'o. � / e111 �
1' ° G 1967
Date " 196,/ Permit No S // 6 -7,/
_
Fee $ ,?3 Si
n•r nl nr17Y�Elh .
ApylicakionCsfhcreby�maelgttp.[he Cdy of Cupertino fora 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
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,n
State License
Address
_ Address
Approvddlt i tarn n PENIEVIGH
PLUMBING INSPECTOR t/
FIXTURES I NUMBER II MAIN DRAIN
UNUS1 FEES 11 UNITS FEES
Shower I/ 1 11 To PraD. Line I I I
Not Conn.
Sewer Box
Wash Tray
STORM DRAINAGE
Washin 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
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Toter Cf
Total Fee fji