51002Aly
NO.
LOT NO.
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
w VY4 SIF as'
r Sanitary i\o.3o 196_ Permit Noe0�
w LL / G 2 Fee $ S`
xo (`pp
Application`4iY4iereVrz,
de to the City of Cupertino for a permit to install plumbing
o °<. y" i s and/or fixtures onthe reverse side hereof, and agrees to install said prices
z'N i an or Cy accordance with the provisions of the Plumbing Code of the City of
a w Cupertin�tnfill"cjtf�laws applicable thereto.
a ~ Use of Premises
J LL
O O //
3 OwnerD Of J* /tea b id M Addresy22 00 .f S/� /� ��
O< z fayII • �rf4++� Address
O CONTRACTOR,AGENT
3
Yhon��s- s MC
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rca PP ,2r /
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a ao) State Licenser e A roved
—' f PLUMBING INSPECfORLI--,'
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I FEES
Kitchen ink 1 11 Not Conn.
Dish Washer Z Sewer Bax
Waste Di
urhucm
Wishing Machine 17 I H Size I I
Comb.Sink&Tray I 1 11'['aCurb
np, Fountain
Drain
Ilopper
Size
Restaurant Sink
Material
Said Trap
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
MainD ain Fee O
Water Leader
Storm Drain Fee
Sprinkler Valve
Water -s. Fee
Relief Valve
Gas Fee
Permit Fee
Total Fee