51199.1No.2I?b7 Street SOW COCA QT Lot No. ? 4r_
Iffy of cIIram"o
APPLICATION FOR PLUMBING PERMIT
APR 11971 CITY OF CUPERTINO
Pn �^t Sanitary No.
Date f'L c of , 19$ / Permit No..$//ii. �
Fee Saf 00
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or factures 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. % „
Use of Premises
Owner -)fWr—S IVl J.UAkoLr rM S�
By 19 SAME Avs AgaV E
Contractor, Agent
_ r
Phone
State License
Address
Approv
Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Loyatorics
To Existing
K6tchen 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
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee 0°
Area Drain
Main Drain Fee
Water Le
Fee
Sprinkler System
Water Sys. Fee
Relief Valve
11 Gas Fee
Vac Breaker
5
Skimmer
Filter
Permit Fee 2.00
Total
Total Fee 4- 61m