51068 J
No. Street Lot No.
o —
n
s APPBICATIONyFOR PLUMBING PERMIT
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-- . CIYOF CUPERTINO
O
titU Sanitary No.
EC - 9 1969
e:� cY
�F Date /� �t [� t—, 196-
0
1196_ Permit No.
0 lam! V
li 1r" QI1PER INQ Fee
Application is hereby made to the City-of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
c laws applicable thereto.
m
Use of Premises
O Owner Address
rn By A 26,^ ./,Hr..�O
Address /770 A-�'S,l:
3 ifontraetor,Agent
° Phone l V�/ 170
-- -a, State License �9& �79 Approve �
d1' Plumbing Inspector
r � :
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Ex sting
Kitchen ink 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 LeaderStorm Drain Fee
Sprinkler System \Vater Sys.Fee
Relief Valve 11 Gas Fee —F
S
Vac Breaker
Skimmer
Filter
Permit Fee o2, O es
Total Total Fee