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No. Street Lot No-
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ClrY OF CUPZ-UINO APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
JAN 2C 1971 Sanitary No.
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UA,4:i� , 1901 Permit No. /C/ 4��
3 Fee 5 �✓.do
m Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or futures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
O in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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Use of Premises �riid.�d-. aC
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Owner Q 9'/7E;oz ej n e-15;� Address 74"X/i9s2.cxc /7y6-
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„ rn By O�A . ,,r ��.6. Addresse0. /3v�
3 Contractor gent shy/� QUA
m o Phone
A -Z�-� y
—y� State License o16 Approv/ed
lj_.� U Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size +
Water Close[ 3i Material — /
Bath Tub / s To Curb
Shower /6 To Pro . Linc•
Lavatories 715 To Existing
Kitchen ink ° Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine / 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 /• /3
Restaurant Sink Material V4a a.
Sand Trap TOTAL FEES
Urinal Fixture Fee / 0-10
Area Drain Main Drain Fee .fes
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee S
Relief Valve I Ga,Fee
Vac Breaker
Skimmer
Filter
Permit Fee oZ
Total Total Fee /9�0