51231.1 No. Street Lot No.
.c (TAT of CJFMT"O /(P
d APPLICATION FOR PLUMBING PERMIT
—ESEp 2 1971 C-I-T-X0REUPE-RTINO
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U Sanitary No.
Permit No. .5Z2 j�
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3° Fee$ ;L 6.5W
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 Plumng Code of the City of Cupertino,and all other
'E laws applicable thereto.
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A n Use of Premis
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° Owner Addres
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o � By Address ,
3 r -- Atiz
CC/ontr tor,Agent
Phone �`f5Z.�O
3
^-t State License _ ApprovedflLLIAi%j D. a"gr-`ir^H
V Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen in t 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 3
Restaurant Sink =FixtureFee
J
Sand TrapFEES
Urinal lArea Drain ee ()J
Water Leader eeSprinkler System e
Relief Valve 11 Gas Fe
l7
Vac Breaker
Skimmer
Filter
Permit Fee .O
Total Total Fee