51016.1 No. Street Lot No.
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® Lc� LICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
OCT 1.6 1970
Sanitary No.
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E ^IwPatTIb1A 19 _f/ Permit No. S
o L ii Fee a'z6' 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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
1.2
laws applicable thereto.
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ro U Use of Premises
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° Owner O 6Z7— Address
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By Qrr.O �/JidCzi /-�i5. Address sm, ,;.a
3 Z ContractorAgent
° Phone
— State License ��GT S—/y 7t Approved
/\ Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size y'
Water Closet 3 Material
Bath Tub 2- To Curb
Shower To Pron. Line
Lavatories 3 To Existing
Kitchen in Not Conn
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine / Size
Water Softener Material
Bar Sink 11 To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material o.
Sand Trap TOTAL FEES
Urinal i Fixture Fee /
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief VnWe. Gas Fee,
yv
Vac Breaker
Skimmer
Filter
Permit Fee 00
Total / JZj I Total Fee 6 ;5-v