51220.1a/VO ?' grZlcl �' 1Clk
No. Street Lot No.
M OF CurAn40 APPLICATION FOR PLUMBING PERMIT
APR 2 2 1971 CITY OF CUPERTINO p r/
/l- Sanitary No.
D�p*L•D az ,Iqp! Permit No. S/.�Z-0-i
Fee �2L•J-0
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. i
Owmf7l) J' -
L
Address Wy/ M�hT a.-aC• p"•
SS
Phone 379-' 7a G a
t` State License Approve f✓
Plumbing Inspector
NUMBER
MAIN DRAIN
Units Fees
Units Fees
r
/.Sv
Size °Al. ,
jthb
goo
Material
.s�o
To Curb
1. SV
To Prop. Line
�.So
To Existing'
k
•�
Not nn.
Dish Washer
Waste Disposal
Wash Tray
.1"0
STORM DRAINAGE
WashingMachine
.S�
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size it ,%..
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
I
_
Gas Fee /. SO
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee d(o.Sa