511812 44,Y6 N61 -Lr 0/1✓ 02,
q No. Street Lot No. / !
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.y CITY OF CUPERTINO
WATER DEP(. APPLICATION FOR PLUMBING PERMIT j
MAY 1971 CITY OF CUPERTINO
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Sanitary No.
E Dat 196 _ Permit No��l
0 Fee S �Q
r Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
_ a
_ nd or Fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
o � in accordance with the provisions of the Plumbing Code ofthe City oFCupertino, and all-otfier
'c laws applicable thereto.
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Use of Premises
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0 Owner %L I C H/! A 0 /� k: L t�/Z Address � l6 ifolLY o.+✓, D/?
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= rn By G W N 6 Address
3 .y"e Contractor, Agent
v 0 Phone
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State License DGd J�/�J' Approved
Plumbing Inspector ��
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To ProD. 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
Sand TrapTAL
FEES
Urinal
Area Drain
tFixtureFee
ain Fee
Water Leader
rain Fee
Sprinkler System
ys. Fee
Relief Valve
11
Gaq Fee-U
Vac Breaker
/. ►"'�
Skimmer
4$10
Filter
/. fro
HEq T2 rl
I
?Jdl Sl.t�b'LTP
I
Permit Fee 07. &m,
Total
0
Total Fee Sd