2004 APPLICATION POR PLUMBING PERMIT��
MAR 2 9 1°63 GW-Y'OF�CUPERTINO
Date t4' !}f-Ln ' ; 'r-jk3 Permit No.
Fees S-4
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.
Use of Premises
In
Owner �t��� Gvrleo� AddressF�,�31�
By Address/- 0- w
COI ACTOR AGENT
PhoneApprove
PLUMBING INSPECTOR
t'IXIUKL' UMB' M DR
UNITS FEES UNITS1 FEES
Water Henter / j jI Size fI
Water, Closets /Z jj Material C
Bath Tubs To Curb
Showers o. Pro . Line j
avatj /2. jj g .
Itchen en Sinks N N Conn. I
iSh Washers 8E
Disposals
VVLsTrays j �j STORM DRAINAGE
aching Machines Size
Water Softeners j j Material 4 j
Bar Sinks j jj To Man
Coinb. Sink s Traysj j 11—To Curb
Dental Units
,Drinking Fouutainsj j jl
Moo' Grains j WATER SYSTEM
Hoppers ( -IL-
Size
$ostaurant Sinks Material
Sand TOTAL FEES
Urinals Fixture Fee elj�
Area DrainsF Main Drain Fee 'i;2
Water Leaders _I �� Storm Drain Fee --
Sprinkleryaives I I II Water Sys. Fee, j �.-
T Permit Fee j "=
TOTAL j I#V a-�jjTOTALS'¢
�— RECORD OF INSPECTION
'Partial Rough
Rough Complete
Fina 1
84,06•.M