51016.1 No. Street Lot No.
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iPOCIT
LIGATION FOR PLUMBING PERMIT
E� CITY OF CUPERTINO
is 1970 to USanitary No.
E /� Dat ��O "(�7/[Rg — 1971f Permit No.
3
CITY �f l�Uf LR I SS`IlJ Fee S ` cn
Application is hereby 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
o ; in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
.E laws applicable thereto.
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.ro Use of Premises
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' 0 OwncrSTs�L d.�v /_--r'T Address
= ti By�' U/�l�4cC/,i /`/� Address
3 °' X Contractoj gent
W ° Phone
State License � ��� Approved
lambing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size -5+, /
Water Closet Material CC-
Bath
LBath Tub To Curb
Shower „y To Prop. Line
Lavatories To Existing
Kitchen ink 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 v.
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee S
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee 115
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Vac Breaker
Skimmer
Filter
Permit Fee o2
Total :2, Total Fee C,24K6-0