51131 �U73 I /7A2T/A CuOOD 4%�t`/ LOTNO.
NO. STREET
CITY OF CUPERTAPPLICATION FOR PLUMBING PERMIT
w i WATER DEPT,. CITY OF CUPERTINO
x o �— Sanitary No.
� 0 p(, l 2u 1971��— 3a
o Date 19& Permit No. `fwlj/
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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
> 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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> PHI�t_tPs � E.
3 Owner Address .S'it
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By iJe c j t/3G SE/ ylce' k Address 396 /�E/rnyn� r av S�
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3 F CONTRACTOR,AGENT
— < Phone �Lc7 P/e' 7
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Q,� State License 2 3 -2 114J' Aproved
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PLUMBING INSPECPOA
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FIXTURES NUMBER MAIN DRAIN
Units I Fees Units Fees
Water Heater ,r(3 Size A(Q
Water Closet Material
Bath Tub To Curb
Shower To Pro . Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tra STORM DRAINAGE
Washin 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 0-0
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Bel ef Valve Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total FeeU