51231.1 '1&9�1n&&
No. Street Lot No. 32--
CITY OF CUPERTINO /)
a WATER DEPT, APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
AUG 9 1971 Sanitary No.
E 19 Permit No: /
3 Fee S G s a
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
0 in accordance with the provisions of the lura ing Code of the City of Cupertino,and all other
laws applicable thereto.
0
v
Use of Premis
o V
° Owner AddresSIA=°c
ti
Address
/
3 s Con lot,Agent
d ° Phone ' A/Z41 O
3
n
-u Slate License Approved
0 OPTIurribing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I I Size
Water Closet 3 1 Material _
Bath Tub I To Curb
Shower I To Prom Line v
Lavatories 12, To Existing
Kitchen Sink I 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 S.O O
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee S-O
Reflef Valve I Gm Fee.
Vac Breaker
Skimmer
Filter
Permit Fee . OJ
Total ( ,5 Total Fee " '