NO PERMIT NUMBER F No. Street Lot No.
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m
v APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
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U
Sanitary No.
Date L Z� , 196 Y Permit No.
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3 Fee
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
w and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
Tin accordance with the provisions of the Plumbing Code of the City pf Cupertino,and all other
laws applicable/[ eto. J J\
' Owner 1- 9-./ � /.'��:SiCJ' Address
G _
a m By � Address
3 .S Contractor,Agent
0 h Phone
3
State License Approv
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop.Line
Lavatories To Existinit
Kitchen 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
Sand Top TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader term Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve
Vac Breaker r '
Skimmer
Filter
Permit Fee
Total Total Fee
GAS SERVICE NOTICE OFFICE
COPY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTJN(y
...... ...... r...
4�F..i............................. 19 6.0
To
You are hereby authorized to connect the GAS service for
Owner or Tenant4�t'l%4
ax............................................
At ...
New Service ..... ...........
..............
No. of Meters .... .................. Reconnect .............................
Move Service .......................
No. of Add. Meters .............. Move Meter ........................
P- 7
. . . .. ..........**.......
PLUMBING INSPECTOR