NO PERMIT NUMBER No. Street Lot No.
o —
m APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Urz
a" of CUMMP
APR 2 1911 Sanitary No. 7J
E Date _ — 196 Permit No.
30 P A D Fee$ /.y
00
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
9'E laws applicable thereto.
o .T
= v Use of Premises
_o d 61,' ° Owner .}G-J i C// Address
d
ti By U Address 7'
Contracto Agent
p°' ° Phone a 1�— 5�
a
3 2
�- State License C- S 6 Y'`Y �• Approved
Plumbing Inspector
FIXTURES NUMBERFN
MAIN DRAIN
Units Fees Units Fees
Water Heater Water Closet ial
Bath Tub rbShower o . LineLavatories istinKitchc i o n.
Dish Washer
a
Disposal
STORM DRAINAGE
Machine Size
ftener Material
To Main Drain
k&Tray To Curb
nitFountain
lFilte
Drain WATER SYSTEM
r Size
rant Sink Material
ra TOTAL FEES
Fixture Fee
rain Main Drain Fee
Leader Storm Drain Fee
ler System Water Sys.Fee
Gas Fee
eakerer
Permit Fee o2
Total Total Fee