51177.1c No. Street - Lot No.
B CRT DF CupuTINo
IN FOR PLUMBING
MAR 16 1971 APPLICA CITY OF CUPERTINO PERMIT
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H p
P Sanitary No. _S
E Date " , 196_ Permitil f 7 7'
3 Fee $��
r 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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
'F� laws applica te'tfiFYetc. (��1 1/C
u. `t L1 `
.� Use of Premi t ta]{�- L WCQ
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0 Owner Tom• , /, �,tj/£/Ttrr r�r/.iiy Address
c .v
o h By Address
3 Contractor, Agent
m o Phonex
-a State License Approved
.e Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Bath Tub
Shower
Prop.
Lavatories
Itchen ink
KNn
Dish Washer
Waste Dis osal
Wash Tra
AINAGE
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
Fee
Sprinkler System
Water Sys. Fee
Relief Valve
Gm Fee J%K 7
Vac Breaker
101,41-044
Skimmer
Filter
321
Permit Fee
Total
Total Fee