51016.1 LOT NO.
NO. STREET
,,,APPLICATION FOR PLUMBING PERMIT
co OF CUCITY OF CUPERTINO
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r 0 NDY 1 1971 Sanitary No.
01
Date/ �' �'� I � Permit No 574016-1
i LLP p U Fee S 444-0
O Application is hereby made to the City of Cupertino for a permit to install plumbing
0 a 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
a w Cupertino, and all other laws applicable thereto.
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14 Use of Premises f?ia/hs.!_crr Sim.-S�E t�i11y��/
00
oJ Owner��L '17�� !� Address
Address
O CONT TOR, AGENT
3 � G'jaei9-
- uai Phone,O9
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a o State Licenses�'DSya Approved /
U I PLUMBING INSPECTOR v
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size I /
Water Closet Material c
'Bath Tub / To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen 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 WATER SYSTEM
Hopper Size
Restaurant Sink Material jgoc d.
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Lea er Storm Drain Fee _
Sprinkler System Water Sys.Fee d�
Relief Valve Caq Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total // Total Fee " G J