Plumbing Application LOT NO /
NO. STREEI'
APPLICATIONi{ ffFOR hLURMI �G PERMIT
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o Uute �V 196 Permit No
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O Application is hereby made'-to.the 42ty of Cupertino f rd permit to install plumbing
`o 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
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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3 Owner����.F Ra-x2�-�+• iq�U aye Address DC: �
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z By Q�.l� ,r� (1�X��.,,.(�.°-„ lf. Address'<Z' Hila-Z�
O CONTRACTOR, AGENT
3 0 Phoned53407'7
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aILLIAM D. SENEVICH
` i o State License 2265`3sf Approved W
PLUMBING INSPECTOR t//
FIXTURESWNUMBERMAINAIN DRAINUNITS FEES
WaterlleaterWater ClosetGBath Tub ShowerLineLavatoriesin
Kitchen 5ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine H Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking fountain
Floor Drain WATER YSTEM
Hopper Size
Restaurant Sink Material 67 U
Sand Trap TOTAL FEES
Urinal Fixture Fee .J
Area Drain Main Drain Fee J'b
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee /.
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee