51015 c No. Street Lot No-
0
u APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
0
HSanitary No.
m
(ate 11967-0 Permit No. �O�i7r
3 f SEP 16 1970 Fee$ _
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 A(\ -Waccb ince wi@ Sh@1 1ovisl s of the Plumbing Code of the City of Cupertino,and all other
\ \ •. \' i'J
L. laws apphcable thenit1 5�. \
V Use of Premises \`10
�O.�t4-1 ' f Z 0CC u�ANC 1
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Owner 1, r O C S 1\u ltrL tel'�l L Address t w y / d �eJ
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a BYIC 1�4 �� � ai i c 4K 'rrbt�l�n4 Address
3 s ICContractor,AgentO O
0 Phone e?41/- 9000
^� State License 1/p d.?
2t7 Approved
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size '{y
Water Closet Material CI
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
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 C•
Sand Trap TOTAL FEES
Urinal Fixture Fee to
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee 40
Rel4ef Valve 11 Gn�Fee,
Vac Breaker
Skimmer
Filter
Permit Fee y
Total • Total Fee