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'YIT�6F LOT NO,
NO. STREF.i'
971 CITY OF CUPERTINO
MAY 251
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� < APPLICATION FOR PLUMBING PERMIT
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0 P A I D Sanitary No.
o Date --� S 19 21 Permit No,
3 a
O Fee $ 9
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� Application is hereby made to the City of Cupertino for a permit to install plumbing I
0 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.
Use of Premises ��/ i t� AL
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00
> 03 Owner
D sy�'I GSC- l 4 Address
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� z By ,��/'tu,�ruGr �if1�.S �(/'i� Ma-�. Address Il��
O CONTRACTOR, AGENT
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— 0 Phone '9
W w WILLitarri L. EiNe 1lCH
a o State License." G g `� '3 Approved
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prom Line
Lavatories To Existing
Kitchen Sink Not C
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Dain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink. Material
Sand Trap TOTAL FEES
Urinal Fixture Fee .�
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter /
Pool Sweeper
Permit Fee
Total Total Fee ,l0