51231.1 o NOM OF CUPERSO& Lot No.
HATER DEPTT,
a AUG 9 1971 APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
0
U
PAID Sanitary No.
Uate 19 Permit No.S
0 Fee S-Z 6 5
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
E laws applicable thereto.
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„ n Use o(Premis
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' ° Owner Address
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= ti By Address
3 '''),Coont/ractol/ggeenJ
° Phone nGT.S ` /f//r iGG�i
/ lO/ �a
— -� Slate License� Approved
. Plumbing Inspector �
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size
Water Closet Material
Bath Tub 1 To Curb
Shower 1 To Proo. Line [/
Lavatories To Existing
Kitchen Sink Not Cnn
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 9
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee J
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve 11 Gaq Fee
1. S�
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee SJ