51231.1 2 / v016 1ell Ll C- L LOT NO. I
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m CRY OF CUFcRTINO CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
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rSEP 17 1971 Sanitary No.
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0 1) tp 19 1 I Permit No_E[ J-JA /
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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
> I 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 1Le51C e✓LC (Z-
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oa Owner 1-0- I Address Say �7(, C lG (-L�
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� o By ( !'()t�I IP11 CJ Address LJ,ese.)
3 - CONTRA TOR, AGENT
- 0 Phone-2-4: �Z
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02 State License I /b(0 9� U Approved"LLIAPA D. 3ENF_I/if`T{/
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�� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size
Water Closet 2 Material
Bath Tub 1 To Curb
Shower ! To Prop. Line c/
Lavatories 2 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
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee I
Relief Valve 11 Gas F e
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Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee . t)J
Total Total Fee �J