1509 (2) ..�/ 7nZ� I IYNE'ATO A/ OQI�L� LOT NO.
NO. STREET
D R PLUMBING PERMIT
CI F CUPER"
IAPR 24 i�2
I Date 1,49W1L --2 o 19Kg. ' Permit No. �Oq
a CITY OF CUPERTINO Fee $ �ba
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
lb and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
VCupertino, and all other laws applicable thereto.
Pe PP
Use of Premises—Act I-V-&-/1/CL�
v
Owner oTin n A P�Pr/t ri A c Address o
Address
CONTRACTOR, AGENT4
Phone 7 Approv
PLUMBING INS 01
1 • URE MBE MAI R I
UNITS I FEES IUNITS FEES
Water Heater
Size --jj,I
Water -C osets y j MaterialC,1 j
Hath Tubs To Curb I j
Showers To Prop, Line vfj
Lavatories $ To Exist,
Kitchen Sinks No on 2
Dish Washers
Waste Disposals
Wash Trays f STORM DRAINAGE
Washing-MachiW1 1 11, Size j
Watet Softeners j I Material j
Bat Sinks j To Main Drain
Comb. Sink a Trays To Curb
Dental Units j
Drinking Fountains j ;I
Floor Drains j � WATER SYSTEM
Hoppers I Size 9 t/I
Restaurant Sinks Material j/fir.
Sand Traps j1 TOTAL FEES
Urinals j 11 Fixture Fee //,00
Area Drains 11 Main Draih Fee j, p 0
Water.Leaders _� 11 Storm Drain Fee
Sprinkler Vaives j j Water Sys. Fee I /.O U
..e, T j Permit Fee /- 0 0
TOTAL I `m o TOTAL. FEE
RE OR PECTION
PIi
Rough Co to
Final : _� _
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