51016.1 NO. STR EF.T
Kr1 N a My of c1.incAPPLICATION FOR PLUMBING PERMIT
�C CITY OF CUPE.RTINO
y o JAN 2 G 1971 Sanitary No. 6 %�~� Q/=
2 I1
3LLo wa D?{e 19¢1Permit No
!" Fee $3
O Application is hereby made to the City, of Cupertino for a permit to install plumbing
a 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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a Use of Premises '
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o < Owner � � Address Tawn! G'eN�Bt 1N,
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CONTRACTOR,AGENT
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a o (State Licensee-mom' /-°�� Approved
- lk.} PLUMBING INSPECTOR V1
FIXTURES NUMBER MAIN DRAIN
Units I Fees I I lUnits lFeeq
Water Heater 0 Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories _ O To Existing
Kitchen Sink JOEFF Not Conn
Dish Washer 0
Waste Disposal
_Wash Tray STORM DRAINAGE
Washing Machine . O Size
Water Softener 0 Material
Bar Sink _j
rToMain Drain
Comb.Sink&Tray Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size '
Restaurant Sink Material :t✓✓
Sand Trap TOTAL FEES
Urinal Fixture Fee .,Z 4
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee •(l✓7
Total (, Total Fee �`�'