51181LOT NO. //
NO. ST6EEi'
APPLICATION FOR PLUMBING PERMIT
< CITY OF CUPERTINO
Z
r p Sanitary No.
° j Date-���L—�, 19650 Permit No 11J12
": Fee $-�2 J'_-- c e
° /Application -is hereby -4,1 the City of Cupertino for a permit to install plumbing
o < ' ,pipes. and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i , - .ands/or lhxeures 1RF4-ecordance with the provisions of the Plumbing Code of the City of
< w Cupertino, anda1lJother'laws applicable thereto.
w x
I Use Of,'Premisis) rn ,
> H
3 Owner�.
0 T L
o<
ZJ
j z
By 10aX
R-�
° CONTRACTOR, EN
3 0 Phone
w z
¢a /
a o State Licensey-�n'�Y
-u
Address
Approved INTI r 11—
��ri
PLUMBING INSPECTOR -/
FIXTURESNUMBER �� MAIN DRAIN
UNITS FEES UNITS FEES
Water
Shower
To Pro . Line
Lavatories
To Fsistin
Kitchen 5ink
Not Conn.
Dish Washer
/a—t Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
_ To Main Drain
"Eomb.Sink&Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size /
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee 0900
Area Drain
Main Drain Fee c J
Valve
Total Ixy- 1 11 Total Fee � e 0 d