51211D v J I •�Z•( 4ii. C�-•V—� LOT NO. F34- •J . 13
No. STREEI'
LII FOR PLUMBING PERMIT
" < I� OF CUPERTINO
Z2 �I 111111
r o Sanitary No. dZ0
�LL917g '
o 4 1 & 1 b Permit No
a
3 LL Pee $ 3 10
To��(�
o- ASI c�ybn(i Let � dRttIylt�.ity of Cupertino for a permit to install plumbing
o a pipcsitnd/br fizfuresisted on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w =6 2�
Use of Premises
00
3 Owner0'�OLI Address
o a
z
z B}' �%'I.t..c�oe-tn....v �J���w..Q-.~.` Address 2'13 5 A�61... f d-nnua.
O CONTRACTOR, AGENT D
Phone
w z 7-2q7o �
fState License "�.6 `1 Approved-tvO —45kf
' PLUMBING INSPECTOR
? Perm
it Fee
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Total Total Fee Q�t7
FIXTURES
INUMBER 11
MAIN DRAIN
Units IFees 11Units
Fees
Water Heater
61 do
Size
Water Closet
/ 'L- /)
Material C, r�
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
/ 47X16755
To Existin
Kitchen Sink
(v
Not Conn.
Dish Washer
Waste Dis oral
Wash Tray
—
STORM DRAINAGE
Washing Machine
,VC,
I 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
MaterialU
Sand Trap
TOTAL FEES
Urinal
11
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
? Perm
it Fee
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Total Total Fee Q�t7