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No. Street Lot No.
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d APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
° CITY 0�
U CU►[ATINO Sanitary No.
YD,a+tAR z4 1971 , 196_ PermitNol-<
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Fee$
s Appli nAs lVEfeby 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
9'E laws applicable thereto.
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° Owner /�7lL#{/ J-8y'yC��..NGI+�' Address �t ,/'�"
_ yr By fi �(,I� i/,.,i Address
Contractor,Agent
m ° Phone
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State License Approved
Plumbing Inspector .a
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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 Existin
Kitchen Sink N t C n
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 3�
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve / /
Vac Breaker /
Skinuner
Filter
Permit Fee
Total 7!_g Total Fee / �-