51181 (2)LOT NO. 1.7e
h0. STR
APPQ� FOR PLUMBING PERMIT
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Ann' C T ,UPERTINO
ro S✓ Sanitary No.
2 LL
3 < Date 8196 Permit No .S%!Z/
U Fee$ o7U.SU
W LL
0 Applicatifnl' ��++ery��7y�''m pp��fQ�ffy Cupertino for a permit to install plumbing
o W pipes and/orNfi tGre. listed�r(�}> fite{Q�seUde hereof, and agrees to install said prices
> r- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws -applicable thereto. - - - - - - - - -
W Use of Premises T. 2> .
00
r 3
OwnerC �'�J •� Address
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z -1br �Ri ZYK
p By � • �n . Address/__2,K,9
3 F '! CONTRAC756R. AGENT
—m Phone "�"%r �i9o0 `•f -d (ice
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0 a �3 0 % 5
a o State License Approved
-0 X PLUMBING INSPECTOR
Total
J
FIXTURES
NUMBER
MAIN DRAIN
UNITS
FEES
UNITS FEES
Water Heater
I I
A 4-- 1
Size
° d
Water Closet
,2.
-� °O
Material !,E
Bath Tub
/
/ S o
To Curb
Shower
/
/•so
To Prop. Line
Lavatories
..;'•° °
To Existing
Kitchen Sink
/
/• s °
Not Conn.
Dish Washer
/
-
Sewer Box
Waste Disposal
-n-
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drin king Fountain
Floor Drain
WATER SYSTEM
Hopper
Size I
/S 0
Restaurant Sink\laterial
o/✓
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
1v SD
Area Drain
Main Drain Fee
So 0
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
/Sit
Relief Valve
Gas Fee
/SJ
Vac Breaker
Skimmer
Filter
Permit Fee
° n
Total