51231.1 /OD6(4 JqMa.' fir,
No. 5 eet Lot No.
CRY Or CUPERTINO
WATER DEPT, APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
AUG 9 1971 Sanitary No.
A 1 D -d7•� , I9g1 Permit No.j / 3 /
° Fee So2-6
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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 lumbing Code of the City of Cupertino,and all other
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'8 laws applicable thereto.
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.n Use of Premise
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° Owner Address
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By Address hl;,4'111j1;1'0
3 C``ontrac ,Agent
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v ° Phone
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State License 77 ,0 Approved
zp Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop.Line V
Lavatories To Existing
Kitchen in Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 1 Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size 3
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal 11 Fixture Fee . �b
Area Drain Main Drain Fee 0
Water L ader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve. 11 Gas Fep, f. 1
Vac Breaker
Skimmer
Filter
Permit Fee L7
Total Total Fee 7 0