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IYdI LOT No./
APPLICATION FOR :PLUMBING PERMIT
CI �OP CUPERTINO'-
A•
Date_!Pa 19GS
Sanitary No.
Permit No
Pee$ L, s -o
Application is, hereby+m3dt;to•the �City of Cupertino for a permit to install plumbing
pipes and'or fixturesllistedyobklhe'te3erse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino; and all -other laws applicable thereto.--- --
- - -
Use of Premises
�i � �r [.ic.
Owner .� _ Address
By --2— - ori-a%B Addressds..- z- !i. f-!'•
CONTRACT(, AGENT
Phone 7S-- efo7 Le
State License 413o�ya+ Approved WILLIAM D. 9ENEVICH
X PLUMBING INSPECTOR v
FIXTURES I NUMBER MAIN DRAIN
UNITS I FEES UNITS
Water Closet
,3
4- S
Material C.r,
Bath Tub
/
/.s: 11
To Curb
Shower
Hopper
Size /`
To Prop. Line
Lavatories
Restaurant Sink
Material a,4-,
To Existing
Kitchen Sink
Sand Trap
TOTAL FEES
Not Conn.
Dish Washer
/
- -
Sewer Box
Waste Disposal
/
Storm Drain Fee
Wash Tray
Water Sys. Fee
S14
STORM DRAINAGE
Washing Machine
/
�. ��
Size
Comb.Sink&Trav r .1. II To Curb
1G1. Lt V111L
11
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size /`
/
so
Restaurant Sink
Material a,4-,
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
/ S6
Area Drain
Main Drain Fee
— o<
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
S14
Relief Valve
Gas Fee
50
Vac Breaker
Skimmer
Filter
Permit Fee
Total
s = Total Fee
Sp