51231.1 G No. Street Lot No. 2 Al
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.any Gf c0i:0.7M0 APPLICATION FOR PLUMBING PERMIT
t EP 2 1971 CITY OF CUPERTINO
Sanitary No.
p ISD ! D 5��3
Permit No. 1./
° Fee S X. szi
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
° 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 - Use of Premis I
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' ° Owner Address
o � By Address
Contr or,Agent
°
Phone 't`�5-W21,510
A ; ''y� WILLIAM D. E7N3Lr:DH
rr State License J n Approved
1CX V Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub I To Curb
Shower To Prop. Line
Lavatories To Existing
Itchen Sink I Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine I Size
Water Softener Material
BarSink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material ba
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee D�
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee l
Relief Valve ("Aq Fee,
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee