51137 C •S I .�QY E'R CET �R. LOT NO.
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
` QTY OF CUPERTINO
w 4RY OF CUPErnso
s o r Sanitary No.
3EMath� 1971 �'2— /!— 19j,/ Permit No.
AA Pee $ 3. SO
o P kpp!catio 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
aw Cupertino, and all other laws applicable thereto.
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` Use of Premises ✓�
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I. 3 Owner Address S�% nc--•
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J O CONTRACTOR, AGENT
3 Phone -2- 57 `8/07
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a o State License 237 ' o Approved
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— Jf� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater /,•5-0 Size
Water Closet Material
Bath Tub To Curb
Shower To Pro . Line
Lavatories To Existi
Kitchen in N t 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
Sand Trap &FixtumFee
TAL FEES
Urinal Area Drain ain Fee
Water Leader rain Fee
Sprinkler System ys.Fee
Relief Valve 11 caq Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee -2160
Total Total Fee 3. \5-0