51231.1 leo/6 '&
❑ No. Stredl Lot No. .47�
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E CITY OF CUPERTINO APPLICATION FOR PLUMBING PERMIT
WATER DEFT, CITY OF CUPERTINO
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°
N AUG 91971 _
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Sanitary No.
E Date 19L Permit No.�
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° Fee S-2'/ S
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r 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
h in accordance with the provisions of the Plambing Code of the City of Cupertino,and all other
I.'e laws applicable thereto.
Use of Premi
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' ° Owner Address
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By r Address
3 nLC`onntrfjo
!rr..7Agent
d °3 Phone 2T✓ TiG�O
Approv
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-� State License 7 ed
�,` Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prom Line ✓
Lavatories To Existing
Kitchen Sink Not 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 7
Restaurant Sink Material G
Sand TrapTOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee —Q
S
Vac Breaker
Skimmer
Filter
Permit Fee )
Total &AC� Total Fee