100237 ` jcynp s-taycNs caeeK RLytD
No. Street Lot No.
o —
iO CITY OF CU►FTINO
d APPLICATION FOR PLUMBING PERMIT
JAN 2 5 1971 CITY OF CUPERTINO
v Sanitary No.
Y D
, 37
at�JIA 196 PermitNo!Ox
3 FeeS /0
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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'F laws applicable thereto. _
m W Use of Premises
0 Owner /- W/N G.�4`��S (/ Address f�
_ N By—' C.ReM Cp,L Q Address-'�f/S/7/ 7/1/SS/M
3 Contractor,Agent (�fr✓fl F,A y W A 4
° Phone7264
--� State License` e— (0 1 e7 51.7 � ,.1 Approve
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen i Not C
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
Ho22cr Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee,
Water Leader Storm,D ain Fee
Sprinkler System Water Sys.Fee
Relief Valve Cing Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee