51231.1 r�-2142 �ak U\ LOTNn.
NO. F..EI
CITY Ot
F CUPERTINO
" 'an °r cu►a*oiO APPLICATION FOR PLUMBING PERMIT
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SEP 171971 Sanitary No.
o Date 19 Z( Permit No
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Fee $-2-3.a�
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� Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
01 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
a w Cupertino, and all other laws applicable thereto.
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.. Use of Premises eS l Cl Cy\ C.¢.
00
oa Owner 7 Address . lJti Hc' Cci—
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z By C-{N)Je-1 ( 6 Address
o CONTR CTOR, AGENT
3 < Phone 2 �'� —q'� �FC7
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u 2 State License j�& U Apprcy.ed WILLIAM D. PENE!/ICH
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U /� PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
Units Fees Units I Fees
Water Heater I Size 44 1
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existin
Kitchen 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 3
Restaurant Sink Material W I L)
Sand Trap TOTAL FEES
Urinal Fixture Fee 1 13.,;-0
Area Drain Main Drain Fee J
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee 1. J
Relief Valve 11 Gas Fee I. eio
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .p
Total Total Fee , S