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CATION FOR PLUMBING PERMIT
i� ��� CITY OF CUPERTINO
ifDE-C- 9 1970 Sanitary No.
Lot No.
Date /2 — % 1 19t 2a Permit NoS-// ] 7 /
CITY OF, CUPERTINO Fee $
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.
Use of Premises
Owner 7,4 01 cl
By cu0eRT/NO 0Ze1A///3/1t/6--
Contractor, Agent
Phone 2 r 3- 576 / 9-1/
State License 2 CIL O — 2. 3' 3
Address1 /0700 S To /'1F5 AUE
Address 20 K3 z 514 ivdZ'n 06'
Approved" F-zg—
VPlumbing 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 in
t 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
Sand TrapFEES
Urinal
Area Drain
=FixtumFee
eWater
Leader
eeSprinkler
System
Relief Valve,
Gas Fee O
Vac Breaker
Skimmer
Filter
f
Permit Fee 2 r oa
Total
Total Fee G