51001.3- a 3 V-7, I- LOT NO.
NO. STREEI'
AP�PLI04TION FOR PLUMBING PERMIT
iTY OF CUPERTINO
Yoz-,� S 7
FII o _ / (��'' Sanitary No. 0 �'
LL
3a 1) to-- {SEP 9 �9� —`.1196, Permit No S��O� S
w Pee $ Z Sto
nW /AJ`p'plifati�Fs k%e)ay�lt"gt,�he City of Cupertino for a permit to install plumbing
0 i pipes and/or Ixtures fisted on the reverse side hereof, and agrees to install said prices
a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
w x
� r /
w Use of Premises /rte-aCl��
00 A�
o _ < Ownet ��' Jc- s`=�-�-C Addreel-�<--
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z B // �P _ — , Address'�-C/4l
O y CO TRACTOR, AGENT r
3N PhoneQ'?�077
0a oZ �e� %�, Approved
a o State License
r.T - 0 � PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS I FEES
UNITS FEES
Water Heater
I
Isize
Water Closet
%
Material
Bath Tab
/
To Curb
Shower
To Prop. Line
Lavatories
To Existin
Kitchen Sink
Not Conn.
Dish Washer N
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size /
Restaurant Sink
Material
Sand Trap
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
!7400
Water Leader
Storm Drain Fee
S rinkler Valve
Water Sys. Fee
40
Relief Valve
Gas Fee
♦ O
Vac Breaker
Skimmer
Filter
.01
Permit Fee
o
Total
Total Fee
0