51231.1 /l /9 tldewmZO 9t
No. Street Lot No. �.
o
n GfT1' of CUF2MTW0 APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
SEP 2 1971 / �/ Sanitary No.
Y klatch n Ci' " 0)7S . 14Y Permit No. •�/..�.��/
3 Fee S
s 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 P robing Code of the City of Cupertino,and all other
'P laws applicable thereto.
0
Use of Prcmi
o U
° Owner Address
o
c m `
ByAddress
3 Contr or,Agent
° Phone
CitLL1.4�:7 �. T3T_NELrICH
State License JZ/ Approved
�f Plumbing Inspector /
�j �
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size
Water Closet Material
Bath Tub ( To Curb
Shower f To PMD. Line
Lavatories Is To Existing
Kitchen t 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 Stom Drain Fee
Sprinkler System Water Sys.Fee SJ
Rel ef Valve i (,2q Fee, I 50
Vac Breaker
Skimmer
Filter
Permit Fee (.:D
Total I Total Fee 76-5