51114-Plumbing Application jo3 yY ��s� Avt
No. Street Lot No.
O
G" OF'CUMTINO
E
APR 5 1971
APPLICATION CITY OF CUP R PLUMBING PERMIT
°
NP Sanitary No.
- 581
�F Date , 196_ Permit No.
° Fee S 5-00
3
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
° in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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A u Use of Premiseshuov &%OUNDTO0&. 1941)'f 3d x 4g 0CVP too Lk4
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o Owner� Al-e,(r /L_ EUA -,4J Address 163yy L/2'6"' ffYC
c v
C By /-�ov✓�F Q'.UNe�� Address
3 Contractor,Agent
d ° Phone x '6605'
9-!pr 7
II 3eatetdtense Approvee q �
.1/. V Plumbing Inspector ✓
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen in Not Conn.
Dish Washer
Waste Disposal
Wash Tray FMateria:1
TORM DRAINAGE
Washing Machine
Water Softener Bar Sink Comb.Sink&Tray Dental UnitDrinking FountainFloor Urau R SYSTEM
Hopper Size
Restaurant Sink =FixturcFee
Sand TrapFEES
Urinal Area Drain eWater Leader eeSprinkler System e
Relief Valve 11 Gas Fee i.. 0
Vac Breaker al N&4-pp- O
Skimmer
Filter
Permit Fee 2.0
Total f,50 Total Fee