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No. Street
Lot No.
CRY OF COPwwo /It)/%
APPLICATION FOR PLUMBING PERMIT
JUL 21 1971 CITY OF CUPERTINO
PA f Sanitary No.
Date , 19Permit Permit No. ,J /do16
Fee Sat 3e ib
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
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto. �e / '
Use of Premises 11.�C�d.! �+ _ /t / i7
ByAddress�i/w C(V-in/L.f�
Cont for, Agent
Phone
State License Approved f ✓
/V Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
I
Size
Water Close[
Z
Material L.
Bath Tub
To Curb
Shower
!
To Prot). Line
Lavatories
To Existing
Kitchen in
!
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 3
Restaurant Sink
Material a J
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
S
Area Drain
Main Drain Fee
00
Water Leader
Stom Drain Fe
Sprinkler System
Water Sys. Fee
Relief Valve
Gan Fee.
ski
Vac Breaker
Skimmer
Filter
J
PertnitFee �? 95c
Total
To[al Fee 3.
-1—)
S a