51181NO.
a�
LOT NO.
STREE.1'
APPLI&TION FOR PLUMBING PERMIT
Y, OF CUPfRTT _
jai `i S:lnito[nfy N11.
Date VL
Permit No
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes an fside hereof, and agrees to install said prices
and/or envisions of the Plumbing Code of the City
of
Cupertino, and all other ws applicable thereto.
Use of Premises
Owner — C/LRx� Address�.a-x L C'.Q
ByCr• Address/?G
CONTRA Oft, AGENT
7
r1 State License Approved
'� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I PFFH
bath 'l'ub
Cixture Cee /6.5 <'
'Co Curb
Shower
/5-0
To Pro . Line
Lavatorieso
Water Svs. Fee I
'Co Existin
Kitchen Sink
/ S o
Not Conn.
Dish Washer
-
_x
Sewer Box
aste Disposal
Wash Tray
STORM DRAINAGE
`Washing Machine
/ /,5
Size
Bar Sink To Main Drain
Comb.Sink & Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size / 1,
Urinal
Cixture Cee /6.5 <'
Area Drain
Main Drain Fee ,sem
Water Leader
Stonn Drain Fee
Sprinkler Valve
Water Svs. Fee I
ee
Vac Breaker
Skimmer
Filter
Permit Fee
Total %i //. /(., o Total Fee �E sz