51182o
No. Street
CITY OF cwsn4p
APPLICATION FOR PLUMBING PERMIT
Lot No.
APR 23 1971 CITY OF CUPERTINO
��p" Sanitary No.
Dat / , 196_ Permit No.'S1
Fee $ 9 5
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 thereto0
Use of Premises / /' / //' 6201 C�
Owner
��• �/�%/f/ �//;7/_211eeA/Address 1;1/
By��, Address
Contractor, Age
Phone// (� 3�� s
State Licensei /
Approved--
Plumbing Inspector /'
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units I Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Pro . Line
Lavatories
To Existin
Kitchen Sink
Dish Washer
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
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
S rm rain Fee
Sprinkler System
Water Sys. Fee
Relief Valve,
0
Gas, Fee
Vac Breaker
I
Skimmer
I
Filter
Permit Fee � '
Total
y 1wTo[al
Fee