51187.1No. Street Lot No.
CRY of CUPEOM
MAR 31 1971
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
Permit No.4—W %
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
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto. I
Use of
Owner
oe
By
Phone 3 2 ;Z7_17Z
State License x,2.1 (') �f 1
S
Address
Address // a A -L+ 4-z'—p
P.A
Approved
Plumbing Inspector /
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 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
Area Drain
Main Drain Fee
Water Leader
St mDrain Fee
Sprinkler System
Water Sys. Fee
Relief Valye
Cas Fee So
Vac Breaker
/
Skimmer
/
Filter
Permit Fee O?
Total
Total Fee