51135 (2) o7o%s= 40 Ar tr .SSE /
Lot No. A16
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LICATION FOR PLUMBING PERMIT
E _ Nov 12 1970 CITY OF CUPERTINO
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Sanitary No.
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E Date!xI ����i9 , ISt6� Permit No.S .�
3 Fee $3 sm
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 Plumbing Code of the City of Cupertino,and all other
'c laws applicable thereto.
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A � Use of Premises i
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° Owner /C-&J, cqm v 43CL Address o +lit �02Fd7 A�/F
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= By A2✓ V41 Address
3 y Contractor,Agent
° Phone c- y -&'3-3-f
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-' State License =2076 3.G Approved
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 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 TrapESys.Fee
ES
Urinal Fixtu
Area Drain Main
Water Leader Stor
Sprinkler System Wate
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 2-00
Total Total Fee