51175jC GG !-10&7
NO. STREET
LOT NO.C;"L—S
APPLICATION FOR PLUMBING PERMIT
61 P CUPERTINO
Suli[a ry No.
Date pr r — 196_ Permit No vu ,LJ I^0/ ter,
J
Fee $o2-20=
Appliyr,,be'n ihhereby�rmade to the City of Cupertino for a permit to install plumbing
P andlot figres Qt',Yt�,PER h��'rcverse side hereof, and agrees to install said prices
and/or fixtures in acc`oor�d'ince wish the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable
thereto.
Use of Premises q n - 1--`�`^71���L
Owner `Ljc-i...d' 2/11—Q pp^-�' Address
By (h```v"� (Y
"—"W Address—A.",
CONTRACTOR, VNT
Phone
State License L3 ocCD 7 Approved,+�_� __. _ �.._...:i
uPLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITSI FEES UNITS I FEES
N....._LI,.,..�_ Y I
To Curb
To Pron. Line
Lavatories
Kitchen $ink IZ Not Conn.
Dish Washer Sewer Box
DRAINA
v
Comb.Sink&Trav I I I To Curb
Floor Drain I 1 11 WATER SYSTEM
rtopper
Ji ze
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture FeeArea
Drain
Main Drain Fee S L�
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee 5�
Relief Valve
Gas Fee i S
Filter
Z' "
Total I /$ Jo4 2'2-11 Total Fee 177