51113No. Street
QTY Of CUPERTINO
APR 5 1971
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
SATI1TSry'No.--�
DR, *'i dJ , 196 Permit No. -S-111.3
Fee 5 • 5 0
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. Q- , _ _ _ \
Use of Premises
Owner X.
By
Phone 2,1, V-
State License�C2(11/0
Address
Address
+5-7,y
Approved am
(./
Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size
Water Closet
0
Material
Bath Tub
O
To Curb
Shower
To Pro . ine
Lavatories
..e0
To cistin
Kitchen Sink
Mot Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
D
To n Drain
Comb.Sink & Tray
Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size SCOVI
1 k6o
Restaurant Sink
Material LV
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
6,05
Area Drain
ManrBraerFee
Water Leader
-4tvmr-orairr
Sprinkler System
Water Sys. Fee
!. O
Re] Fef Valve
Vac Breaker
Skimmer
Filter
Permit Fee 2.00
Total
00
Total Fee q,SO