51125 No. Street Lot No.
017
m [try OF COPERi1N0 APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
E
U SEP 1Q 1971 Sanitary No.
.G
Y D* A ! D , 196_ Permit No.ef/
3 Fee Sv20 ov
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
T = in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
A o
n U Use of Premises
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' Owner LbeT�i/Ck' Address Q
Ayf_1Pei
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a By Address
3 Contractor,Agent
3 Phone9��—/z7
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State License "'-k/ Approved &44�
T Plun ing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater 1 Size
Water Closet 3' Material
Bath Tub 1' To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink 1" Not Co nn
Dish Washer 1 /
Waste Disposal I.
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
Area Drain Main Drain Fee
Water Leader Storm Drain Fee < n
Sprinkler System Water Sys. Fee /
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee e.2—
Total Total Fee f- , Q O