51126.3 Plumbing Permit, Pool #1 OLOT /
NO. STR EEI'
Cay OF CUFERTINO CITY OF CUPERTINO
z i OCT 4 1971 APDLON FOR PLUMBING PERMIT
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a Datr�'� ' Permit No 1G•`j
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Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w applicable thereto.
Cupertino, and all other laws
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Use of Premises
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3 Owner Address
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O NIRA TOR, AGENT
Phone
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_ PLUMBING INSPECTOR
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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 Existin
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
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Gas Fee
Vac Breaker /
Skimmer /
Filter
Pool Sweeper
Permit Fee '�'
Total Total Fee el