51177.1 (2)Lor NO. J
NO. ET
PT TION FOR PLUMBING PERMIT
" a CITY OF CUPERTINO
m o Sanitary \'u.
�DNo.
to ate -�++ �- � 196Z� Permit
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w �-`,�Q Pee $
= LL `i
LL ° Applita i�r�t Is ereby made to the City of Cupertino for a permit to install plumbing
o a pipes,��1ppd�br fixtures listed on the reverse side hereof, and agrees to install said prices
i a
an r, stores In accordance with the provisions of the Plumbing Code of the City of
a w Cu ertmo, and all other laws applicable thereto
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a Use of Premises .f
J 4 /
00
3 Address -'
Jz � /—�.L�H /L<`�K�t�t� Address ft pit J
CONTRAC O , AGENT
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— Phone �3
w z-17-7
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a State License '
Approved ro
— PLUMBING INSPECTOR /
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
/
Size
Water Closet
Material
Bath Tub
/
To Curb
Shower
To Pron. Line
Lavatories
Existine
Kitchen Sink
Not Conn,
Dish Washer
Waste Disposal
-
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.S ink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Fe
Sprinkler System
Water Sys. Fee /
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
/
Total Fee i21