51177.1 (2)/0,V9�/os,-r,� ASE
No. Street Lot No.
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�LICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
DEC 91970
Sanitary No.
`c 9
E at 1941 Permit N-'7d'17/Z
3 CIT 1 ��� Fee $'��
r 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.
0
Use of Premises
SAN
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' ° Owner Q ��(� S , A xiMA�l Address
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a ti By Address
3 Contractor, Agent
° Phone o�!.7 '�—Ar,5<
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State License Approvedla!LLIAw D. B'cIVEVICH
Plumbing Inspector
1'
Permit Fee a--�-
Total Total Fee -r'q
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen in
N C nn
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 CP -
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water.Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
1'
Permit Fee a--�-
Total Total Fee -r'q