51135No. ,Stt jt ,.,((�� Lot No.
APPL7CATIONPERMIT
CITY OF CUPERTINO
Date '�Vv '5-- , 197--1
Sanitary No.
Permit No.
Fee $ ;• ->
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 the pte�1
Use of
�41M"�
Phone -�/O� � Q / 0
State License x '3 0/ :5�Q
/0370
Address 1776-5. Of
T
Approved�dE
/Plumbing Inspector _ --
FIXTURES NUMBER
MAIN DRAIN
Units Fees
jUnits Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prov. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
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
Hopper
Restaurant Sink
Sand TrapL
MRSTEM
FEES
Urinal
e
Area Drain
Fee
Water Leader
in FeeSprinkler
System
Fee
Relief Valve
11 Gas Fee
Vac breaker
Skimmer
Filter
Permit Fee —oz- —1-v
Total
Total Fee J, \4nrd