51181 (2)d /ice I LOT NO.
�APPC CATIONpFOR PLUMBING PERMIT
d CITYl OP CUPERTINO
x o APR 15 1368 (Is:mitary No. v
0 a Date r. - `" n 11996 r Permit No
3
U ♦' I t tT Nit Pee $ 3 d
x LL
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o w pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
j LL Use of Premises �T '—D
0 0
> N
, 3 Owner �/�''�� Addre9s�_,�-.+�
0 o zj
gy � o Address��u«To
3 r
CONTRACYOR, AGENT
— m Phone 5�7.5� Pao 0
w z
a
0 s State License Approved
Pi G. rr�i�ls. J:GI'1
.0 PLU7NG INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
Water Leader
UNITS
1 FEES
UNITS FEES
Water Ileater
3
,
1 Size
Water Closet
Vac Breaker
3.00
Material e.— .
Bath Tub
/SO
To Curb
Shower
/
Sp
To Prop. Line
Lavatories
od
To Existing
Kitchen ink
r/
Not Conn.
Dish Washer
/
- -
Sewer Box
Waste Disposal
_
Wash Troy
STORM DRAINAGE
Washing Machine
/
/. J
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Restaurant Sink
\1aterial 6a1,1.1
Sand Trap
TOTAL FEES
Area Drain
Main Drain Fee
o0
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
3
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
7 1 -,?,5--1 Total Fee
S v