100252 j03 o/ s t-`e & 9- so• N/!L1/E g_
No. Street Lot No.
0 —
.N CITY OF CUPERTINO
d WATER OEPT,, APPLICATION FOR PLUMBING PERMIT
EAUG 5 1971 CITY OF CUPERTINO
U
Sanitary No.
TP
.Ex Date WA 114 Permit No% .� 2-
0 Fee$3 1 a
3
s Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
W and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
0
:e :a Use of Premises
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0 Owner A dress
c_ ti ByI/YTS A.///� , Address -P�6�Z �'
Contractor,Agent
° Phone
66 w
'—la State License I� j Z Approved
umbing Inspector
1
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen in 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 TrapTOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee