51231.1 ILOT NO.
NO. STa EFT � ' I
CRY OF CUPcgWLICATION FOR PLUMBING PERMIT
z a 7 CITY OF CUPERTINO
r o JUN 8 191 Sanitary i\'o.
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3 J Uat� . n 5 —!y 1901 Permit No �' 3�• /
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Fee $
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� 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other lawtplicabl thereto.
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Use of Pr ises
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3 Owner Address
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Dy Address
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— 0 Phone 7i7 /Is ��j? ��/ / �'��
ao State License ��!(� / �U oApproved �(
V �.♦//3 PLUMBIN INSPECTOR X\
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FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / 146DI Size
Water Closet Material L.
Bath Tub I To Curb
Shower To Prop. Line
_Lavatories To Existing
Kitchen SinkNot Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
W
ashing Machine Size
Softener Material
ink To Main Drain
.Smk&Tray To Curb
Dental Unit
Drinking Fountain
Drain WATER SYSTEM
er Size
urant Sink Materialra TOTAL FEES
l Fixture Fee aDrain Main Drain Fee .CO
Leader Storm Drain Fee
kler System Wator Sys.Fee r 'j0
11 Gas Fee
ffFilter
Permit FeeTotal Fee OIL X50