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PPLICATION FOR PLUMBING PERMIT '
CITY OF CUPERTINO
5 1971 sanitary No. — --
Datep .4 ! .3 — I9� Permit No. S/ /q.Z
Fee $ W c
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. rr��
Use of Premises ` /C.�.A a,Ti ,er Gm sf�y" L
Owner NA-rulj VSoM. if/. Address .0 e f -,e
By 4 C- - PL/3 C. Address39L AfUZ v I O& -r 4 (1 s/T
CONTRACTOR, AGENT
Phone c) 7 F/ o?
State License 2 3 7 'i G Approved
or
PLUMBING INSPECTOR
FIXTURES
INUMBER 11 MAIN DRAIN
Units Fees Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Pron. Line
Lavatories
To Existing
Kitchen SinkNot
Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
- Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink 8c Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
11 Cm Fee,
Vac Breaker
Skimmer
Filter
--
Pool Sweeper
Permit Fee Y , o 0
Total
Total Fee . J 7�