5113219651 'D2AKEDR. �^I
No. Street Lot No. d 13
cny OF CUP3.IMO
APPLICATION FOR PLUMBING PERMIT
APR 9 1971 CITY OF CUPERTINO
Sanitary No.
Rpp t
tNA t i 1L- 9 , 19�]� Permit No.
Fee $ 2.5-0
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.
Use of Premises
Owner A LLAtJ 9
By BIMe G W al ES
Contractor, Agent
Phone a -S- - S9 -1 S
State License V\ 61M P OulkB r—
Address 196,T1 V RH V Eh2 _
Address
9-71
Approved
Plumbing Inspector
Permit Fee r • OO
Total Total Fee 1 3.5-0
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
Kitche ink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
'Po Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Tra
FEES
Urinal
Area Drain
=MaterialSand
eWater
Leader
eeSprinkler
System
Relief Valve
Vac Breaker
.C...`..
Skimmer
Filter
Permit Fee r • OO
Total Total Fee 1 3.5-0