1519 103 AI 11//G/(S<SZJ 6d O12i vAA- LOT NO. /
NO. STREET
APPLICATION FOR PLUMBING PERMIT
v �9�T(A OF CUPERTINO
1 Dat ^, " 1301 ,-19d= Permit No.Qjffl
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Fee $ O O
a o¢ h�� City of Cupertino for a permit to install plumbing
P /or xtures ste on a 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
V _ Cupertino, and all other laws applicable thereto.
& Use of Premises I7ES/Od-A/C t-
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� Owner CuPf/tT.�a //�PaPrR7/L-r Address //iPPaT.ni. �„„r
gy16vAO Y //L I/M 4'/All— Address L
CONTRACTOR, AGENT
Phone _72F-6FIll Approved
PLUMBING INSPECTOR
1'(9Z'CiJR�S UMB 3R [ DR
UNITS I FEES 11 UNITSFEES
Water Heater i / Size it
Water Closets Material C/
Eath Tubs To Curb
Showers f To Prop. Line
Ta :Ori(: To Existing
Ritchen Sinks Not n
Dish Washers ( ��
Waste Disposals � ( � ��
Wash Trays STORM DRAINAGE
Washing Machines
Water Softeners 1 11 Material j
Ear-Sinksl 1 11 To Main Drain
Comb. Sink a Trays 1 11 To Curb
Dental Units 11
Drinking Fountains
Floor Drains WATER SYSTEM _
Hoppers Size I
(Restaurant Sinks Material GA[p.
Sand Traps TOTAL FEES
Urinals ix ore Fee %/,0 0
Area Drains I Main Drain Fee
Water Leaders _� �� Storm Drain Fee
Sprinkler VaivesI I Water Sys. Fee I /. o O
Permit Fee /. 00
TOTAL I TOTAL FEE /y, 0 0
RECO D SPECTION
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