51231.1 / SS et - Lot No. �
c UA' OF CUPERTIF
ro WATER DEP[,
E
AUG 9 1971 APPLICATIONCITY OF CUPERTINO PERMIT
0
U ®/ — / Sanitary No.
c rm
(O �L
c Date , 19 Peit No. -J-/ 31/
Y
3 Fee S -5-6
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
0 in accordance with the provisions of the lumbing Code of the City of Cupertino,and all other
"'e laws applicable thereto.
0
;, ro Usc of Premi
o_ U
° Owner Address
o t
c
a Cl 6y Address / LA-1
3 Cf(outracto Agent
0 ° Phone
3 I77 �
State License X Approved
1� Plumbing Inspector-�
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub ( To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink ( Not
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 TOTAL FEES
Urinal Fixture Fee C�
Area Drain Main Drain Fee ^v0
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee (�
Relief Valve Gaq Fee,
(. O
Vac Breaker
Skimmer
Filter
Permit Fee J
Total 1 / .i Total Fee - S