100243 /o�ii \-�
a e4C6O0 eupQrwatreet Lot No.
o —p
APR 8 1971 APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
S A 1 D -�-_
Sanitary No.
E Date 7 } , 19fl Permit No/
3 Fee$ O O
s Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or futures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
o A in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'E laws applicable thereto. r
Use of Premises e
/r�Gz
s ° Owner i �K/fJJF� �iQU�.r-bi s�C.i
y U Aadrec� r
Y
3 ontractor,Agent
o Phone
3 r� p'7�
\i State License Li �7 O Approved
Ike 414bng Inspector f
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Not
inn
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
La at
' s T E
,Dish Washer
Waste Disposal
Wash Tra STORM DRAINAGE
. Washin 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 Material
Sand Trap TOTAL FEES
Urinal Fixture Fee 6,00
Area Drain Main Drain Fee
Water
Sprinkler System Water Sys. Fee
Relief Valyc Ga.%Fee
Vac Breaker
Skimmer
Filter
Permit Fee _
Total O Total Fee