51231.1 a� 44- I i/1r, Ps�l� , (� l,yY LOTNO. 341-
No. S EE.I' n ,-t
CITYa OF CUPERTINO
w crrr of cuffiInAPPLICATION FOR PLUMBING PERMIT
f Sanitary No.
Y ° SEP 17 1970 b ( S71 di i
R _
o a Uate 19 _ Permit No
3u
4 P A p Pee $ .73. SI/
� o
� Application is hereby made to the City of Cupertino for a permit to install plumbing
o < 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 ap
plicable thereto.
LL Use of Premises PS lCl.�l CE.
00 I cc
3 Owner�JC Address :__; -LG-
0 < II /-� l
z By ( L(1 .1l w/ 1 Address V t �h /le
0 CONT ACTOR, AGENT
3 �
- 0 Phone
wz
u i State License ' �� 8 Approved WILLIAM D. BEKi3Ylt'r-T
/71& PLUMBING INSPECTOR /
X
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub ( To Curb
Shower I To Prom. Line
Lavatories To Existing
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 �j
Restaurant Sink Material p
Sand Trap TOTAL FEES
Urinal Fixture Fee .S[7
Area Drain Main Drain Fee
Rel ef Valve 11 Gaq Fee Is-b
Water Leader Storm Drain Fee
Sprinkler System Water Sys, Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee