51001.2� Aaz7-3 s I /T+� '& • LOT
NO. STREEI'
APPLICATION FOR PLUMBING
` II OF CUPERTINO
Sanitary Nu
PERMIT
Dat S-/ d O /. .7./�
Pee S �•
Application is hereby made top Ore
Cit , of Cupertino for a permit to install plumbing
pipes af(1i,j'�rY(ix I �Y IX reigse side hereof, and agrees to install said prices
and/or Rxtures in actor ante ah the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner X l/
By,CO
V
State License.
1-3-13 VJ
Address'j-
Approved WILLIAM D. SENEVICH
PLUMBING INSPECTOR /
FIXTURES I NUMBER MAIN DRAIN
UNITS I FEES 11 UNITS I FEES
Shower
To Pro . Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
Sewer Box
Waste Disnosal
Size
Softener
Comb.Sink&Tray I 11 To Curb
Drain
Si ze
W
urtnal 11 Pixture Pee 1 (O
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys. Fee
Relief Valve Gas Fee / SO
FA
Permit Fee 0 u
T
Total ,� otal Fee � A'G