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NO. STREET
APPLICATION FOR PLUMBING PERMIT
�h d CITY OF CUPERTINO CITY OF CUPERTINO
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xR AM 21 Sanitary 1971 _
o No.
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o ate `� O 191 Permit No
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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3 Owner ( off FC L 2) , xr �r ,Address c$ 4/'r 0—
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J z By, /{-Ct— IPL/3C St RVl cc' _ Address s3 i-C- �F/[R YhO v7 'a
o CONTRACTOR, AGENT
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— 0 Phone 2-!j '7 F(0'7
aY ,State License 2 3 -7 7 as- Approved b7
t"}\�' PLUMBING INSPECTOR
FIXTURES JNUMBER MAIN DRAIN
Units I Fees Units Fees
Water Heater ,J Size
Water Closet Material
Bath Tub To Curb
Shower Pro . Line
LavatoriesE tin
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 t rm Drain Fee
Sprinkler System Water Sys. Fee
Retief Valve Gaq Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee -
Total Total Fee ,�