51231.1 VY1vlJ� U 1,1.� COT NO. 1 �/
NO. STREET . 1 1 0
CR'( OP.CUPERTINO CITY OF LCIIUPERTINO
1971APPLICATION FOR PLUMBING PERMIT
x 0 LSanitary No.
o a gXteA D '�_ 1 lq� Permit No. 3 A �
3u
iLL Pee $
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o a 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
wCupertino, and all other haws applicable thereto.
Use of Premises 1� �S�C] P✓lC E
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, 3 Owner_- ( Address,.C l(l_Yl L, da rc -
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� z By C. COLI—) 1 �l P'j � Address b ''I/�/� ✓�l�
CONT RActrOR, AGENT
3 < � � - 4240
0 Phone
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a o nState License LL ApprovedWILLIP"n
l� n PLUMBING INSPECTOR ✓
4-1b .
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater be Size
Water Closet ✓ Material c'_
Bath Tub J To Curb
Shower V / To Prop. Line r�
Lavatories To Existing
Kitchen Sink V Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 41 Size
Water Softener 11 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 Trap TOTAL FEES
Urinal Fixture Fee SO
Area Drain Main Drain Fee CkJ
Water LeaderStorm Drain Fee
Sprinkler System Water Sys. Fee Q
Rel4ef Valve 11 Gas Fee
V
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee U(�
Total L12Laffeeo