51231.1 p No. Street Lot No.
° Z9TY OF CUPERTINO
H WATER DEPT,
m APPLICATION FOR PLUMBING PERMIT
E AUG 9 1971 CITY OF CUPERTINO —
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_ r A 1 ® Sanitary No.
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. � Date , 19g Permit No. r3%1 3/. �
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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
° N accordance with the provisi f the Plu ing Code of the City of Cupertino,and all other
claws applicable thereto.
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Use of Premis
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Owner Address
a ti By / Address
3 s ConictAor,Agient
0 ° Phone
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State License Approved /
0 Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line cl
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 1 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 J
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stom Drain Fee
Sprinkler System Water Sys.Fee O
Refief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total 1 ,rj Total Fee