51167 (2)/G-F--'31Ctjm�.�
NO. STREP.I'
LOT
APPLICATION FOR PLUMBING PERMIT
,a G TY OF CUPERTINO
Dare � 41 ' f � ,,196
Sanitary No.
Permit No -'5 /�/& 7
Fee $ -? `—o
ApAlica i n r erek.�} d t the City of Cupertino for a permit to install plumbing
pipesLand16r PuureZ1���C1[ �thOre erse 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 J7
+/e
Owner
g/ l SD✓
lAddress
By //Va-&L SA&1 O10.c
Address
�/ C/�ONTRA R, AGENT
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State License lX7� / Ioqy ApprovS
ITJ
PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
Floor Drain
UNITS FEES UNITS FEES
Water HeaterSize
Size
Water Closet
Material
Bath Tub
To Curb
Shower
'ro Prop. Line
Lavatories
'l'o Existing
Kitchen ink
Not Conn.
Dish Washer
we,Box
Wash 'Gay H STORM DRAINAGE
Wa.hi, Lachine Size
Comb.Sink & Tray I I I I To Curb
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
I Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee