51189o No. Street /0/7j PryarLWnoD DA-. Lot No. 3
C" Of cupsam
aAPPLICATION FOR PLUMBING PERMIT
E JUN 18 1911 CITY OF CUPERTINO
°
Sanitary No.
P A I D
E Date Yh raY 2O , 191-2 / Permit No. 5:i PC?
3 Fee S 7�6 3-
r 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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
'c laws applicable thereto.
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,v A Use o(Premises ,L tgyniDn--y, Yj OO
n. off' BGprr 33�
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° Owner AV E/2--f GD NS T'. Address479 C,cXV-r 0 'Y sW
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=h BY,-j-osErn F-rGNr'?v,�rc4t_Address/665— 6Z-06E25' /QUE
3 Contractor, Agent /�
° Phone '-75— 9Z)4- �— �� .� ( 1
— � State License Z-6 q- 2— i3 S Approved Qv
lambing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size'i
Water Closet
Material C• /•
Bath Tub
To Curb
Shower
To Prov. Line
Lavatories
To Existing
Kitchen ink
Not Conn,
Dish Washer
Waste Dis osal
Wash TraApIAM
I I P°
STORM DRAINAGE
Washing Machine
1.100,
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Ho a e{
/ 1 s.
Size
Restaurant Sink
Material CO?.
Sand Trap
TOTAL FEES
Urinal
Fixture Fee 1 30
Area Drain
Main Drain Fee
S --
--Water
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
I SO -
Relief Valve
Gws Fee
18�
Vac Breaker
Skimmer
Filter
MFee
Total
30
3°i