51231.1 ae
"'20
. treet Lot No.
`" CIT4 OF CUPERTINO
d - WATER DEPT. APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
AUG 9 1971
DD � Sanitary No.
E DatP.e � PI
`O � --,)i( 19 Permit No.
Y
3 Fee S,2 i
s 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
n.E laws applicable thereto.
Use of Premi
o U
� ° Owner Address
o 2
C n
c N By Address
3 s Contra r.A ent
d ° Phone
— ; State License O `lpproved /
`, _t_ ` ��/ Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size 40
Water Closet .3 Material G
Bath Tub I To Curb
Shower r To Prop. Line
Lavatories '� To Existing
Kitchen Sink t Conn,
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washin 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 'S
Restaurant Sink Material t
Sand Trap TOTAL FEES
Urinal Fixture Fee ac-
3-Area Drain Main Drain Fee 47 A3
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee �_ O
Relief Valve (-,w%Fee.
r.
Vac Breaker
Skimmer
Filter
Permit Fee . JJ
Total I .5 Total Fee 2 6 5