51231.1 22134 1 0A& \PCUC. O l\ LOT NO. � (I
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CRY OF CUFZRTINO CITY OF CUPERTINO
" < APPLICATION FOR PLUMBING PERMIT
ro SEP 17 971 sanitary .No.
° a Ut -7(e 19 � Permit No
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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 laws applicable thereto.
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Use of Premises �2eS l PwtC
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o a Owner Address Q O f C1.
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° CONTA CTOR, AGENT
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Phone 4-
o f State License—,LG 6 9 Approved WILLIAM D. BENEVIr_H
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Ute/ PLUMBING INSPECTOR .� '
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater f Size
Water Closet 7- Material
Bath Tub To Curb
Shower I To Prop. Line
Lavatories To Existing
Kitchen Sink 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 Cro J
Sand Trap TOTAL FEES
Urinal Fixture Fee I vQ
Area Drain Main Drain Fee 3
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee NT
r. S
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee oj
Total Total Fee 3. J