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o &?.DP CUPERIftreet Lot No. ZO
WATER DEPT,
EAUG 1 1971 APPLICACIOTY OF CUPERTINO N FOR PLUMBING PERMIT
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A ■ ® Sanitary No.
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x Date aA,- / 1196 Permit No. 6
3 Fee S�
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
laws applicable thereto.
m Use of Premises
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Owner L 86- Address
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BY U/�I Address /7 7.1
3 � Co//ntracto ,Aktnt
v ° Phone
— State License 7 37Z Z WILL!21%1
Plumbing Inspector v
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
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 jFixture
Restaurant Sink
Sand Trap :aF
ES
Urinal Area Drain Water Leader Sprinkler System
Relief Valve 11 Gas Fee
f
Vac Breaker
Skimmer
Filter
Permit Fee �-
Total Total Fee