51231.1 `Vo3MoJsy 1 /1U.-` 1...- OT NO.
NO. STREET l ( it`
Can OF CUFUTINO CITY OF CUPERTINO
" < APPLICATION FOR 'PLUMBING PERMIT
x a SEP 17 1971 Sanitary No.
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0a Ua(C D I`' � q 19 Permit No 3
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10
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.
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w Use of Premises P5 (d e'A CP-
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oa Owner t' Address j to l e� C Ife (�(�---
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By l ,�r�1.��� {� V .l Address �v I`li V�
3 CONTR ,C{TOA, AGENT
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0 y State License 1 (IGG 9 ApprovAVILLIAM D. Rcnr r.......
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f,L� PLUMBING INSPECTOR �/
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower I To ProD. Line v
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washin 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 j
Restaurant Sink Material J
Sand Trap TOTAL FEES
Urinal Fixture Fee 13. 20
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee 5u
Relief Valye I Gas Fee To
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .p
Total Total Fee