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4ANUU ATION FOR PLUMBING PERMIT 3 N T3
® CITY OF CUPERTINO 9 .
jNOV r 31970
Sanitary No.
C11�t�§DT'wf)' 1970 Permit No. 5)I
TV Fee $ 'A1 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.
Use of Premises ACT'S
OwnerZZL/ Ga K3-5—r.l-n
By Sa>1 s cG M �r ritC.A(— lox.
Contractor, Agent
Phone �-1i -gocf�
State License 4
Address 1(.(s 9'n( E2S Aiy. 4J.
1/-19-70
-App ved
XPlumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size
Water Closet
I
Material L
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
I �'
To Existin
Kitchen in
N C nn.
Dish Washer
Waste Dis osal
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
Ho er
Size 1
I Si
Restaurant Sink
Material
Sand Tra
TOTAL FEES
Urinal
Fixture Fee
—1 v°i
Area Drain
Main Drain Fee
S,
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
j 0
Gas
i V °,0
Vac Breaker
Skimmer
Filter
Permit Fee
v °�
Total
Total Fee