51135 /U y O J L AA 4,4
No. Street Lot No. _
0
® D LICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
E r'
U ,fJAN 2 '1 '971 Sanitary No.
E Date 2-U . 19z� Permit No.
si113 f
0 CITY OF Fee 3
s 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
'e laws applicable thereto.
A o
Use of Premises
v n �7
o ° Owner ! 43, L1�/�}��j t-f i2 2S�A�ress ll1 �OC C 1tRR%TR.FQ
c C By q61V 14 111,rI- PLwM,6•.r4 Address ;-/E 72- 6AIw,}�,�
3 Contractor,Agent
0 o Phone
- � State License x.53 q11 L Approved WILLIAM D. 13cN'=yICF
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater —size
Water Closet Material
Bath Tub To Curb
Shower To Prov. Line
Lavatories To Exi tin
Kitchen in Not Conn.
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 y
Drinking Fountain 14 lop
Floor Drain I WATEBZVSTEM
Hopper
Restaurant Sink A terial
Sand Trap TOTAL FEES
Urinal 01 Fi cure Fee
Area Drain Main Drain Fee
Water Leadeli I I Storm Drain Fee
Sprinkler Sys Water Sys. Fee
Re]ef Vnly�, 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee Z�
Total Total Fee 57J