51236 yYo Yo /Yi`rTEA� LOT NO.
NO. s"F.F.a'
CITY OF CUPERTINO
a car °P C'JAPPhICATION FOR PLUMBING PERMIT
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Y p JUN �g 7 Sanitary No. 7 30 1�:-
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o a bate 9ly� ,'19 71 Permit No e'S✓Z-�(e
3U P A D Cee $ d 7
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o Application is hereby made to the City of Cupertino for a permit to install Plumbing
o a 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
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a Cupertino, and all other laws applicable thereto.
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Use of Premises F/r/✓/GE TAT/o,�/
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o a Owner rJry113!_C moi/_ Address
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� z ByddGG/&AA✓�A9B//✓e, 60 Address/S'fG �•1'% /41d T.
CONTRACTOR, AGENT
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Phone ✓� L
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ftO State license L Approveme,,y /
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U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size .06
Water Closet Y ggl Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories 3.o To Existing
mk /f Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size t
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain /.S'C
Floor Drain .Toj I WATER SYSTEM
Hopper Size /V#
Restaurant Sink Material
Sand Trap /aa TOTAL FEES
Urinal fc Fixture Fee Sc.<o
Area Drain 3,.c Main Drain Fee .oe .
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee ,Tp
Relief Valve 11 Gas Fee
Vac Breaker '✓
Skimmer
Filter
Pool Sweeper
Permit Fee -71'..
Total Total Fee _o 0