NO PERMIT NUMBER (3) No. Street Lot No.
APPLICATION FOR PLUMBING PERMIT
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Date '74
I �W 3 N" Permit No.
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Fee S Z.jV
Application is hereby madq%TM qqrofl6uP5�.n8fo .a pernnit to install Plumbing pipes
and/or fixtures listed onthe�re�verlesidi�hereo6,.�-nd-arr
e ito'13stall said prices andjor fixtures
in accordance with the provisions of the Plumbing Code of tl�e City of Cupertino,and all other
laws applicable thereto.
Use of Premises a'(P'7C e
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Own AIV04t, &2 Address ��f^IZW 644'i'W
By So" ,7� r1A 6 - Address ��/L' 70se
Contractor,Agen
Phone �29,3-9 0 7
12 3(f 9 3 J� VVII-Llf-.�',j D. BZNEVICj
State License - Approved
x Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size 4/-
Water Closet Materia 7'
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existi"
Kitchen Sink Not Conn.
Dish Washec,
Waste Dis"ol
Wash Tray STORM DRAINAGE
Washing Machine 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 I MateriaVkJO
Sand Trap TWAL FEES
Urinal Fixture Fee I
Area Drain Main Drain Fee
Water Leader Stom Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve Gm Fee
Vac Breaker
Skimmer
Filter
Pe Fee
Tc�Totai taliLFee