51181 (2)LOT NO. I / I
NO. STREE'Y
APPLICATION FOR PLUMBING PERMIT
irk I��R CUPERTINO 7
y a ® Sanitary No. _
LL
o a Date 819 t• Permit No.
wLL Fee$ o%i •rG
o �F,�
A licati�{}� ,,1� er"� yj�--m qq tt�� �}yp� y Cupertino fora permit to install plumbing
o r pipes and/ 'r�P t�tret,Srtedat I ERT l s ide hereof, and arees to install sid 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.- - - - - - - - -
w x
LL Use of Premises
00
r 3 Owner "Z` — Address ;Rf^ .U''' (�W�t .brie!
0 J // A'
z By Address
O CONTRACT GENT
- z Phone
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ao State License Approved /
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-0 1 PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNI'PS PEES
Water Heater N •s'S Size S
Water Closet � _. Z Material /;I- -r
Shower
/
/.570
To Pop. Line
Lavatories
,.ed
To Existing
Kitchen Sink
Sprinkler Valve
.So
Not Conn.
Dish Washer
/
— o _
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
. S J
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.SinkBTray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
[topper
Size / `
I ] /•Sl)
urinal
11 Pixture t, cc
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
H-5-0
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
00 I
ITotal 1 7 1 1..i?S ,�j Total Fee I --)q S d 1