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JUN 18 1971 APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
PAID
Date Yn t4Y ZD , 19/ % /
Sanitary No.
e
Lot No.
Permit No.—S// OF
Fee $ 115Z
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
laws applicable thereto.
Use of Premises POO c.. F Q ✓ r P'7- +7n 9N T 012-0 D
mY.
Owner ,AP VErl—Y CDI"S -7—
By
By �5Riy "TDSE Yn EGri r4N� cox.
Contractor, Agent
Phone 9 D 4 4—
State License 2.6 4- 2.8
Address 47 9 G. A97n.o V i Zw
Address ie6 5 t0 -o 6 Em -V xC G.
Approved
Plumbing Inspector
�1� 1 � �� Permit Fee 2 pOH
Total t 'i Total Fee I� S,
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size ¢"
0°i
Water Closet
Material C.I-
Bath Tub
To Curb
Shower
To Pro. Line
Lavatories
To Existin
Kitchen ink
Not C n.
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
Size PO
S'Di
Restaurant Sink
Material co?.
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
I Si
Area Drain
Main Drain Fee S
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
i
5j
Vac Breaker
Skimmer
Filter
1Wo� 5 u n.? I / I
�1� 1 � �� Permit Fee 2 pOH
Total t 'i Total Fee I� S,