51075.11 (3)/o � -7 TQu. 4 Pru LerIir' 0" xt ijro RL,
No. Street ��T— Lot No.
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CUPE�
d Ct7Y Gr APPLICATION FOR PLUMBING PERMIT
o {l C v 2 9 1971 CITY OF CUPERTINO ,
U
P Sanitary No.
ro
�F. Date , 1901 Permit No:,S
3 Fee$-2y
z, 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
'E laws applicable thereto-
. 12 f
� Use of FrQxmses
o U
O Owner 'e Addre
��, x Ad'��d/!`ress
3a Contractor,Agent �a lla>�
�0 Phone J ya 7 l
State License '�i 3 I r O Approved
C Plumbin pect
FIXTURES INUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet 0 Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories , To Ex' tin
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 7/ _ WATER SYSTEM
Ho er Size 1 1 1, :?
Restaurant Sink Material
Sand Tra TOTAL FEES i
Urinal ) Fixture Fee I • J��
Area Drain Main Drain Fee
W er Storm Drain Fee
Sprinkler System I Water Sys. Fee
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total S Total Fee