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No. Street 0 Lot No.
pPf OF CUPR'TNO APPLICATION FOR PLUMBING PERMIT
MAR 2 3 1971 CITY OF CUPERTINO
Sanitary No.
Die A —196 Permit No /: 7
Fee S l�—
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
Owner E, L • qct *—,
BYS,�r4yu'e
Con aCctor,' gent
Phone z.rJz,—/0
State License '`?
,/mJ[LtOfc��
gf3 LFR✓>s ley /e/
Address /OS&3 LFgves1'x'al
Approved
lambing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units I Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
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
Arealin
Main Drain Fee
Water Leader
Stom
Sprinkler System
Water Sys. Fee
Relief Valve
Gaq Fee,
Vac Breaker
Skimmer
Filter
Permit Fee 6'O
Total
Total Fee