51003 LOT No.
D o APP AFOR PLUMBING PERMIT
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(JUN 1 1985
ly OF CUPERTINO
W
r p i-- Sanitary No.
� LL 3 U 1 196 Permit No SSG Q 3
w LL v' 1 Fee $ L
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plurqbing Code of the City of
< w Cupertino, and all they laws applica thereto.
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Use of Pre ises
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� ; Owner Address /Ot� i�
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CONTRACTOR, AGENT
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Phan,���OJ�
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WILLIAM D. IRENEVICH
ao .State License Approved
—0 PLUMBING INSPECTOR
FIX I URES NWNfBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To.Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
,Wes'h Trays STORM DRAINAGE
Washing Machines Size
'Water Softeners cY Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
F=loor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water—Leaders Storm Drain Fee
Sprinkler Valves / �2 #�Z Water Sys. Fee
Permit Fee o2 am-
TOTA_L1 TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final.... .