51133 /OJSS -v I 91-e `Fi eT LOT NO.
NO. STREE.I'
CITY OF CUPERTINO
" < On Or rueaAgPLICATION FOR PLUMBING PERMIT
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Sanitary No.
0 Date 19 71 Permit No s//1-4 3
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0 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
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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0 a Use of Premises
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" Ss7 �Y17 An
r 3 Owner G! Address
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z By k014 6f7l /—i1q v- Address/ Z/7 5441,C.r/I A .
3 0 CONTRACTOR; AGENT✓ p �'/
- `m Phone -? 7�- 7lP S �1)Y►t/� L/
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ao State License 2�0 2.�fS Approved
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 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 Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve I Gm Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 2r dT>
Total Total Fee $. S O