51125 IO O j I J/1� LOT NO.
NO. STItEE .
CITY OF CUPERTINO
" < APPLICATION FOR PLUMBING PERMIT
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3 a Date �L� 19 Z/ Permit No.
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NOV 29 1971 Pee $ .2
o Application is hereby made to the City of Cupertino for a permit to install Plumbing
o 1 pipes at orA(stpre.0sted on the reverse side hereof, and agrees to install said prices
> r and/or tfehtfcR id ac oordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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3 Owner,Lz, ty.,,+� Address //J ,h felt I. ,c•f"./,t.Pr!� r •
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ONTRAGTOR, AGENT
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- Phone TS-_ /7 i�'—
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a o 'tate Approved
U PLUMBING INSPECTOR
4
FIXTURES NUMBER MAIN DRAIN
Units I Fees Units Fees
Water Heater / - Size
Water Closet 3 Material
Bath Tub To Curb
Shower To Prom Line
Lavatories -3 To Existing
Kitchen in Not Conn.
Dish Washer /
Waste Disposal
Was 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
Restaurant Sink =Fixture
_ Sand TrapFEES
Urinal Area Drain eWater Leader eeSprinkler System e
Relief Valve Gas Fee
50
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee �- —
Total Total Fee