51226No. Stre
Lot No.
n CRY OF CUPENTMO
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APPLICATION FOR PLUMBING PERMIT
JUL 21 1971 CITY OF CUPERTINO
_v Sanitary No. -- -
EM Date Y UatD�
e � , 19 � Permit No. S/1.a6
° A Fee $a3•�7!
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
0 in accordance with the provisions of the PI tubing Code of the City of Cupertino, and all other
n
laws applicable thereto.
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n n Use o(Premise I
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' °Owner Address
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=_ v, By Address
3 z C ntrac r Agen
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— -a State License /\
Approved
1 Pluing Inspector' J
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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 Sink
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
Restaurant Sink
Material Go
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
OJ
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
11
Ga� Fee
Vac Breaker
Skimmer
Filter
Permit Fee
03
Total
Total Fee
St)