51231.1 10060 IWlos5y 0&^K Ct LOT NO. IS
No . STREET h I )
CITY Of CUPERnNO CITY OF CUPERTINO
= SEP 2 1971 APPLICATION FOR PLUMBING PERMIT
r O _ Sanitary No.
3 LLZ J2 l 3 /,
3 a 13 Ujfir 1_(n—.��_ / � 19 Permit No S
U Fee 014•sb
w w
x O
Application is hereby made to the Cit}' 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
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,
w x
a Use of Premises ILP$ L 2rn C 2
J 0
7 N
3 Owner e— Address ✓1 �G— C a C`
0 <
`oa
zJ
z By Cf OW I Q .1 CQ Address Ur l L✓\ t C .,j
CONT ACTOR, AGENT
�— 4 �>
— m Phone
w z
w w
z State License I b 1 ApproveWILL!AM D. Ez1Lr/!CH /
y' PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater l Size
Water Closet 17 Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories 3 To Existing
Kitchen Sink Not C nn
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 3
Restaurant Sink Material U
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee �. S
Relief Valve ll Gas Fee
C�
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee -tom
Total 11 Total Fee . �