51211/0 L/ 5 i I �)1 CL'1 S LOT NO. /3 4--P' D
NO. STAF.FT
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No. -%0 ZZ
U U,',12C� Permit No UW
4ao Pee $ a 31W��9g
hbade 7G
to the City of Cupertino for a permit to install Plumbing
Pipes acid/or fixtures list �Qq' µjy�((��everse side hereof, and agrees to install said prices
and/or fixtur n -��i�S MIk provisions of the Plumbing Code of the City of
Cupp,,(, g ill TtRef 40
Owner
thereto.
Use lof Premises 16 4
Owner_(!e) Address
By )1 7 Q�Qw.n.<< l' iclGc.�-C..�..t-!
CONTRACTOR, AGENT
Phone 391--3-.59-t
State License
k
Addresstk'1-55 ?L". 4rr.ce.s
1-29 70
Approved__'`
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
Units
Fees
I Units Fees
Water Heater
,(o
Size
Water Closet
YL
,O'
I Material L5-rcb
Bath Tub
J L,
Od
To Curb
Shower
To Proo. Line
Lavatories
To Existing
Kitchen Sink
z/8
NotC nn.
Dish Washer
/ (.7
,u
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/4,
W,Gr
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
Material '
.�U
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Re] ef Valve,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
Total Fee , 7