51179 (2)�y %S/ I ✓ _�^^n"/�.rZ"Ci V.C" LOT NO.
NO. STRE
APPLICATION FOR PLUMBING PERMIT
z d Y OP CUPfRTINO
x o i!'1 Sanitary Nn.
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o a Date u /`�, I 6��, Permit No
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� Application is hereby, made to the City of Cupertino for a permit to install plumbing
o 1- pipes ane{,�,� to(q�Its i side hereof, and agrees to install said prices
i in and/or fiztil'Te�inkefcord�l�e�&ifA t�Vp'lovisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto. Q
Use of Premises SG/l i ro'+ / 00
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r 3 Owner�41S a1 iW,4A/ Address 10/-6/ 4FEP.f DS,-
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z By S!//IJK/ST POOLS, Address Y5: E. FL 64n710i)elev
J O CONTRACTOR,AGENT
3 Phone D
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p a ? O % 24 O Approve /
State License
PLUMBING INSPECTOR /
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FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
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
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
/
Filter
j
Permit Fee oL c,-'
Total
Total Fee d'tl