51231.1 IVV LF— I M055V QLK C� LOT NO. 1
No. STREETl I 1 � _ 1Z
GTY OF CUFERTINO CITY I OF CUPERTINO
" a APPLICATION FOR PLUMBING PERMIT
xi
SEP 17
1971 S:mitary No.
30 Date 19 1� Permit NoU IFA I LOP
`
w LL Fee $ 024. .)—D
To
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
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
u x T
Use of Premises �/` {'S 1 QA C
00 I
r3 Owner {\0- DI? Address�s , c, �. lck-r-c---
o_ J I C� Vl - UIPUj
z By1 r�� lP�� Address V�.
n CONT ACTOR, AGENT
3 < 24� - 42 �lc�
��Phone I- (� R
o State License I "� � ` " Approved WILLIAM D. BZNEVICH
U0- A .
-<\ PLUMBING INSPECTOR j
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size
Water Closet I Material C.
Bath Tub To Curb
Shower To Prop. Line ✓
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine I Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size 3
Restaurant Sink =FixtureFee
Sand TrapFEES
Urinal Area Drain eWater Leader eeSprinkler System e
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
=FFeeTotal (D p