51064NO. STREET
- A,PP_LIC4ATION FOR PLUMBING PERMIT
z a ` _ — `= I� ilk Y OF CLI ERTINO
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0 a Di—' �J Permit No.l d
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�y Fee $
Application is�a"'JR�rinTJ V)the City of Cupertino for a permit to install plumbing
o LL a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
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3 OwnerD/:i ' Address
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a State License i j Approved 4�
U PLUMBING INSPECTOR
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GAS SERVICE NOTICE OFFICE
COPY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Vic................ ................ 196..E
To
You are hereby authorized to connect the GAS service for
0 "ner or Tenant ... /�G�c %`--—L��-1�%� = = L. l.. .... ........
At..-- ----- -------- -- --- ------- -- ----------------
New Service ../..................
No. of Meters /.................
Reconnect ------------- -------------
Move Service ........................
No. of Add. Meters .............. Move Meter ------------.._..._-------
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PLUMBIINSPECTOR
O2 .1 d 1 -r e'v- LOT NO.
NO. STREP.I'
APPLICATION FOR PLUMBING PERMIT
lro�C TY OF CUPERTINO
I��
San ary No.
Date `- - 9 196 Permit No G OfC
.. Pee $ /Z
pi��cphpQris to the City, of Cupertino for a permit to install plumbing
rrfi/drlfixtdre� j't ei fty%� reverse side hereof, and agrees to install said prices
and/or fixtures in accordance witlS the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
C/ r/ C/
State License / I -)3 e/' S
Address
Addressl�3 �/ 7 ��
PLUMBING INSPECTOR✓
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
1I Prop. Line
Lavatories
TO Existing
Kitchen §ink
Not Conn.
Dish Washer
Sewer Box
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 I I
Filter
Storm Drain Fee
Water Sys. Fee
Gas 1' ee
Total Fee