51222.1No. Street
Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO CITY OF CUPERTINO
,UN 28 1971
Date u� — 02 3 , l;? -z
Sanitary No.
Permit No. s/w37./
P A I D Fee S .7
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
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto./J
Use of Pre/mises
Owner .� Address ZZa 76 //
fC,-
C'/'C;-
4-1
f
Contractor, A t
Phone >c6y_'Ia'3 7 I
State License '='Ze 0 S/ O
Address q D . Ad
WILLIAM D. GENCVI
Plumbinq�Spector L/
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size 5"
Water Closet
3
Material C,2,
Bath Tub
Z-
To Curb
Shower
/
To Prop. Line
Lavatories
3
To Existing
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 o -d
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
Gas Fe
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee 0-0