100244 / 9 6A,,e .Clic% :.� Gt_c c .�d
a No. Street Lot No.
0
CITY OF cu"XMO
E APR 14 1971 APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
0
HP w D_ Sanitary No.
FT /g
�F Date / , 19 L Permit No./Ord d
00 Fee
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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
0
Use of Premises
_o U
Owner [iYVCa Address 60
00
a N BY ( O Address
3 /trac ,Agent ry
0 Phone 735
State License Approved
�- Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pron. Line
Lavatories To Existiniz
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine '
iMze
Water Softener aterial
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Ho er Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee q
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Rel ef Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
' Permit Fee o2
Total Total Fee o"°