51032 /00eo Alo 131�h� r
No. Street Lot No.
°
CITY OF CUFNI11,1O
o. APPLICATION FOR PLUMBING PERMIT
MAR 15 1971
CITY OF CUPERTINO
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Sanitary No.
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i E Date — 1 ;L- , 19�� Permit No.'s /
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0 Fee S 0
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
n.E laws applicable thereto.
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Use of Premises C
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Owner o Address
BY Address d s `—•eL 1 L 5
3 Contractor Agent LL11
° Phone
�3-15-7i(�
— -� State License Approved • C't't'� '�
Plumbing Inspector ✓
FIXTURES NUMBER MAIN DRAIN
Units Fe
Fees Units es f
Water Heater i Size
Water Closet Material .n✓" ,�
Bath Tub / To Curb s'
ShowerTo Prop. Line
Lavatories .�' To Exis'tin
Kitchen Sin c NArCr�
Dish Waster 0
Waste Disposal
Wash Tray STORM DRAINAGE i
Washing Machine .00 Size 0�1'
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curbl'
Dental Unit „✓'
Drinking Fountain
Floor Drain /' WATER SYSTEM
Hopper A Size
Restaurant Sink Material Co its MT. 1.50
Sand Trap ! TOTAL FE
Urinal .f Fixture Fee •0�
Area Drain Main Drain Pee
Water Leader Sterm•Dmin'FLT
Sprinkler
'System Water Sys. FefA
Relqcf,Valve Gas Fee
Vac,Breaker
Sk er
Filter
Permit Fee Z .
Total Total Fee