51016.1 No. Street Lot No.oZ
o —
m APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
V
_ Sanitary No.
c
x DatPermit NoS/ 4/E./
3
Fee $�_
Application is hereby madeof Cupertino for a permit to install plumbing pipes
and/ fid(yre ed { whereof,and agrees to install said prices and/or fixtures
in ac ce th ov ions of the Plumbing Code of the City of Cupertino,and all other
c laws applicable thereto.
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P =
= v Use of Premises
' ° Owner�rTE�/U r+� Ci7CJT Address
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By "tea C//Q�GGS'G1 /��/��— Address/= d. a.t &I..ZL
3 s Contractor, el tt
° Phone -2 tL'�'�
$-21-70
State License �" a Approved
PI mbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater db Size 1{'
Water Closet Samba Material C.
Bath Tub 5"v To Curb
Shower To Prep. Line✓
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine a't, 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 =Fixture
Sand TrapFEES
Urinal Area Drain eeWater Leader eeSprinkler System e
Vac Breaker
Skimmer
Filter
Permit Fee
Total /.7/ X Total Fee ,}�