51124 Zo-3v / I G/CLIC/` 41A LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z a CITY Oh CUPERTINO
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x O Sanitary No.
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3 Date 191 Permit No, S 7SL
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_U 1 ,^K) Pee $ �2?
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° APpli�ti s er y made to the City of Cupertino for a permit to install Plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
aw Cupertino, and all other laws applicable thereto.
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Use of Premises
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oa Owner�TJ}TO . N • Address SSA r C-
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z ByAet-FLB(G Address.354 P&RRvn0kT A✓ S/5--
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� CONTRACTOR, AGENT
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— Phone 2- 9 —7 / 07
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a o ate License Z •3 y0 Approved
U PLUMBING INSPECTOR
FIXTURES INUMBER 11 MAIN DRAIN
Units I Fees I I lUnits Fees
Water Heater I f 1 /,S-,Jllsize
Water Closet Material
Bath Tub I To Curb
Shower To ProD. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
,i Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 11 Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM _
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee A sc
Area Drain Main Drain Fee
Water LeaderStorm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve 11 Gas Fee.
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 1
Total Total Fee S, G