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C" *""APPLICATION
CVrlRTMOAPPLICATION FOR PLUMBING PERMIT—"
w = JUN 18 1971 CITY OF CUPERTINO
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x pSanitary N o.
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o a iRteA r:A 2D 19r / Permit No
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iFee $
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
> 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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Use of Premises 1-19 y -/Z) rL y d20o r>
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o < OwnerAVP- `r cyo. s77. Address479 e2*-5-L2o— rnT, via-
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�, By-MAr" "OSE AddressY666- P-0600- 22VE
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CONTRACTOR,AGENT
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Phone 275- C/ 0
z 44-
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a o State License 2.642:8 5 Approved /
PLUMBING INSPECTOR v
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FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size 4—
Sc`.i
Water Closet
Material
Bath Tub
To Curb i
Shower
To Pro .Line
Lavatories
To Existin
Kitchen in
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
159,11
STORM DRAINAGE
Washing Machine
'X115
Size
Water Softener
MateriaL�gjm�
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Ho er
Size / I
I 1 S,
Restaurant Sink
Material Co ?.
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
3 e °%
Area Drain
Main Drain Fee
S °%
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
I
Relief Valve
Caq Fee,
i
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
LTotal Fee I
L1 10-