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g CITY (IFLot No.
F cuPERTW0 Street i�
_
WATER DEPT,
d APPLICATION FOR PLUMBING PERMIT
E AUG 9 1971 CITY OF CUPERTINO
ySanitary No.
P- A I ® � �1s: �
E Date 19 Permit No. 3L/
3 Fee $ OL
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
`o in accordance with the provisions of the PI tubing Code of the City of Cupertino,and all other
ro'E laws applicable thereto.
0
ro ;, Use of Premise
o v
° Owner Addres
o
c M
__ rn By Address
3 s ) �C/ontra or,Ageen/t
0 ° Phone CX�f 5J' L'Y`Q
" 3 /.lid
-c State License m Approve
L, Plumbing Inspector (/
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line r/
Lavatories To Existing
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
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size 1.5 ¢
Restaurant Sink Material J
Sand Trap TOTAL FEES
Urinal Fixture Fee _
Area Drain Main Drain Fee of
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Ga.%Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee