51113 / 6 .2 r7 & 0- 6'9?'12 1- 37 YL ,
No. Street Lot No.
° CRY OF CUPERTINO
WATER DEPT,
u APPLICATION FOR PLUMBING PERMIT
E AUG 2 3 1971 CITY OF CUPERTINO
O
Sanitary No.
E Dated„ Z , 19bg� Permit No. S /Ad
!o
3o Fee 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 Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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ro A Use of Premises
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v Owner 14 : CO 72 T >Z Address
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a ti By j��q Address s7 S s��,.N.•rs
3 .5 Contractor,Agent X
o Phone L �! 3
State License L O 9 G ApprovedVj1LL1AG4 D.
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 i
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
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
WaterLeader t rm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve i
Vac Breaker
Skimmer
Filter
VTo7tal
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