51230v to 02 0 / "IL
No. Street Lot No
0
d APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
ySanitary No.
%o I IV V l9d / Permit Nom Z.;?
3 Fee $�
Y A lication is hereby made to the City of Cupertino for a permit to install plumbing pipes
G'I //o ur � QLF�t#�� j�(erse side hereof, and agrees to install said prices and/or fixtures
0 ro m aredfdancc�Aith ArJ� fi i.61b�s of the Plumbing Code of the City of Cupertino, and all other
8 laws applicable thereto.
Use of Premises �41 /y!/"i��7'" _-
Owner
By RAY L. HELLWIG
PLUM 121.COntFct gnt
y/-
G Co
Phone °
State License e 3 — //J Y KJ
Address
Address /57
Tel
v
Approve `�
Plumbing Inspector
.20& 0 Xo_
No. Street
Lot No.
CRY OF CJFE.Y"
MAR APPLICACIOON OF CUPEMFOR BINO NG PERMIT
5 1971
P A r,) q Sanitary No_
Date rE43 � / , 19t i Permit Nod
Fee $ 42 ;z
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.
Use of Premises
Owner kcl//l/G&,
RY j(/O C — s^ 17
XZAGO-
}�/%
Contractor, +
Agent
Phone VjS — 3 3 / O ('p
State License C-16 — .24 q d 7
Address
Address'��0 /&Z.0 A!!P—
S ..i
Approve44
49 Plumbing Inspector r%
Dish Washer
To Curb
Water Sys. Fee
! O
0
r]
FIXTURES NUMBER
Units Fees
Water Heater
Water Closet
Bath Tub
Shower
Lavatories
Kitchen Sink
Dish Washer
Waste Disposal
Wash Tray
Washing Machine
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
Drinking Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water Leader
Sprinkler System
Vac Breaker
Skimmer
Filter
Total
MAIN DRAIN
Units Fees
Size
Material
To Curb
To Prop. Line
To Existing
Not Conn.
STORM DRAINAGE
Size
Material
To Main Drain
To Curb
WATER SYSTEM
Size
Material
TOTAL FEES
Fixture Fee
Main Drain Fee
Storm Drain Fee
Water Sys. Fee
Gns Fee
Permit Fee
Total Fee