51192.2No. Street
pry' BF cum"INo
99
E MAR 18 1971
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APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
Lot No.
Date , 196_ Permit No.4 /
Fee Sy_
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 theretg,,, I
Use of Premises
Owner IZ11 h n , NJ` 1J/— -:�-f L
By
Contras r,/ g nt
Phone -!:�— — 3
State
Address
Address ,x7 /v it/h-11i
Approve
lumbing Inspector
FIXTURES NUMBER
Units Fees
Water Heater
Water Closet
Bath Tub
Shower
Lavatories
Kitchen
Dish Washer
Waste Disposal
Wash Tray
Washing Machine
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
Drinking Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water
Sprinkler System
Relief Valve
Vac Breaker
Skimmer
Filter
op
Total
MAIN DRAIN
Units Fees
Size
Material
To Curb
To Prop. Line
To Existing
Not Conn,
STORM DRAINAGE
Size
Material
To Main Drain
To Curb
WATER SYSTEM
Size
Material
TOTAL FEES
Fixture Fee
Main Draun Fee
Storm DFee
Water Sys. Fee
Gnq Fee
Portrait Fee
Total Fec