51016.1 a/�oa l l'Md� Ivy e
No. Street Lot No.
o —
° APPLICATION FOR PLUMBING PERMIT
d
a CIiY G7 CUFu-.itNO
E CITY OF CUPERTINO
FES 23 1971 Sanitary No.
3
x Da 2 �
, 19� Permit No.S/ 106-/
3 Fee SQC?,o 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
.I'c laws applicable thereto.
O o p
A n Use of Premises
lies rwevtc
_o U e
° Owner C.. Address a�a 4.o MCC/ella„R�r
c
By Address
3 ^ ontractor,Agent
nt
o Phone P�3 1= 7 / I
3
State License 2welb mE17 V' Al. ved
CI5
`� Plumbing Inspector t%
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size 411
Water Close 1 Fury 3 Material
Bath Tub a- To Curb
Shower '.L To Prop. Line
Lavatories To Existing /
Kitchen i Not
Dish Washer
Waste Dis osal
Wash Tra turacC STORM DRAINAGE
Washin achine Size u 1t
Water Softener Material Tl L
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size 9
Restaurant Sink Material eow
Sand Trap TOTAL FEES"
Urinal Fixture Fee 2250
Area Drain Main Drain Fee /1 -50
Wate Leader St rm Drain Fee
Sprinkler System Water Sys. Fee /-50
r.5o
Vac Breaker
Skimmer
Filter
Permit Fee 2 .00
Total Total Fee '2cf, 0 0