51016.1 LINI>v. PLActzLOT NO. 39
NO. STR F,F,
APPLICATION FOR PLUMBING PERMIT
w i TY OP CUPERTINO
20 �� Sanitary No.
a a J / O / 6.>/
o Date — Permit No
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i LL Fee $ 1�3
° Afy�licanon is hereb- made to the City of Cupertino for a permit to install plumbing
`o pip �x, ,&ur6U1 ���tnlneverse side hereof, and agrees to install said prices
> : and or fixtures in accordanfr 1��t{he provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto. "
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Use of Premises i n A IUGF
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0 3 Q OwnerkA
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� zpyW CC IA was 1" LVI/K 131 Address 11 3 E, Ey ELw k)
° CONTRACTOR, AGENS �T�
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— Phone Q g 8q 00
� y 14 � �0 7-/470 ..
c State'License �] A\pIproved
f` PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater size 4 5' 00
Water Closet 17Material
Bath Tub 13 CC I To Curb
Shower .CC I To ProD. Line
Lavatories 10.51 To Existing
Kitchen SinkI Not Conn,
Dish Washer
Waste Disposal
Wash Tray 1 I O STORM DRAINAGE
Washing Machine l 1, 5D Size
Water Softener Material
Bar Sink 1 To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size 1 I. S70
Restaurant Sink Material..
Sand Trap TOTAL FEES
Urinal Fixture Fee 3.3.G0
Area Drain Main Drain Fee 0
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee / •S�
Relief Valve
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Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total 33,0 Yrotal Fee O D
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