51016.1 No. Street Lo[No.
o —
APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
0
y D
.c
Sanitary No.
Y Da[ 177 1 Permit No.
0 Fee S oZ 3 S-
Application is herebxx made to t'h•e,�ity of Cupertino for a permit to install plumbing pipes
a andtTur��iste@'�rlRv� e hereof,and agrees to install said prices and/or fixtures
o in a 6 d nce rth t c provtswns o t e Plumbing Code of the City of Cupertino,and all other
z'c laws applicable thereto.
" o
Use o(Premises
o_ v
0 Owner Address 73'�Rcoev•
o °1
c
=_ in By �P� y /�/�n Address /�r,J- 3o.c
3 Contracto ,Agent
0 Phone e1 Y8— G 3
1, T-19 T�
�' State License o.2�o C2 ��� \,,approved-
J( Plu bing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater 15� Size IK t
Water Closet Z c' Material 0,;7.
Bath Tub /av To Curb
Shower / /rO To Prop. Line S�
Lavatories " To Existing
K' /' Not Conn,
Dish Washer
Waste Disposal
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 P,
Restaurant Sink Material C'�.v.
Sand TrapTOTAL FEES
Urinal Fixture Fee i
Area Drain Main Drain Fee S o0
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee /S
Relief Valve 11 Qa,�Fee
Vac Breaker
Skimmer
Filter
Permit Fee d
Total /Js'11 Total Fee o?3zso