51253No. Street Lot No.
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v APPLICATION FOR PLUMBING PERMIT
EApR 2 2 1971 CITY OF CUPERTINO
v Sanitary No.
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x DateP A/'�" Permit No.s�
° Fee S
3
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
c laws applicable thereto.
A a Use of Premises
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o0 Owner/ i/r� �°�i,1/ Address
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B y /z e �i
Address /.;2 /% ,OEGLG Q�G
3 ! Contractor, Agen
m ° Phone
3
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Ary bio � �S
State License Approved
Plumbing Inspector ,�
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
I Fees
Water Heater
I Size
Water Closet
,ee
I Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
/ 773
To Existing
Kitchen Sink
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
Sze
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee L•�
Area Drain
Main Drain Fee
J3.0%
Water LeaderStorm
Drain Fee
Sprinkler System
Water Sys. Fee
r0
Relief Valve
11
Ga� Fee
O
Vac Breaker
Skhnmer
Filter
Permit Fee
Total
Total Fee
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