100244 h0. STR EE'1'
CITY OF CUPERTINO
" < APPLICATION FOR PLUMBING PERMIT
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r o CRY Of CUPERTINO Sanitary No.
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° Dat 19 — Permit No� OR
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Ay 17 1971
Fee $
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° Ap�catiQn if h{tyby made to the City of Cupertino for a permit to install plumbing
o < pipes d/ fifto s listed on the reverse side hereof, and agrees to install said prices
r : and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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o a Owner M {i/0. (*f)-^3T u 0 Address 's"
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J , By ave /B I,, I/ Address tri �3– /
o CONTRACTOR, AGENT S I Orion gO
0 Phone 7V 3 s .
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a o [1te License `'<2 vo A.? Approve
—0 APLUMBOIeNGINSPECTOR
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FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater - Size
Water Closet ,p Material
Bath Tub To Curb
Shower 3 To Prop. Line
Lavatories G 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 `l, WATER SYSTEM
Hopper / Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total t Total Fee 0