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NO. E.
ET I V C7
CITY OF ClfPERTINO
" < ern ar axuv°APPLICATION FOR PLUMBING PERMIT
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r o SEP 17 1971 l unitary No.
o J Date 19 Permit No _
56 P A Pee S_3• 5-0
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� 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
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 CS ICAPnl'
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3 Owner J Address 0.,u l if C/Q f C�
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z By[C��le�-1 C. ) Address WLn \ I J
O CONT �AICTOR, AGENT
w W Phone 4s T2 9
e a I C� 9 4 8 IMLLIANT D. BI_N-�/]CH
a o State License Approved
Nv. PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size "
Water Close[ 2 Material
Bath Tub I To Curb
Shower I To Prop. Line v
Lavatories Z To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 1 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 1 '7
Area Drain Main Drain Fee
Water Leader StormDrain Fee
Sprinkler System Water Sys. Fee I
Refief Valve 11 Gas Fee
I. SO
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee J
Total Total Fee T J