51189p1 o
No. Street
QiY OP CUPEETINO
APPLICATION FOR PLUMBING PERMIT
DEC 22 1971 CITY OF CUPERTINO
I r Sanitary No.
Date //40 Permit No..S�
Fee S_
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
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.
Us(
m
By
c.onuactw, ngcui 2980 Winchester Boulevard
Phonei-P- ��/ Camg ll, California 9500E
State License , /Approved
r �Y Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
0 "
Material
Bath Tub
To Curb
Shower
6
To Prop. Line
Lavatories
0 //—
To Exist in ✓
Kitchen i
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 /i
Restaurant Sink
Material C• .:.i_
Sand Trap
TOTRL FEES
Urinal
Fixture Fee 40 • ,2d
Area Drain
Main Drain Fee e J
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee Q
Relief Vnlye
Gas Fee ,2 o J
Vac Breaker
Skimmer
Filter
Permit Feel
Total
Total Fee d. To