NO PERMIT NUMBER (3) IDI3G I A FjGG P. LOT NO. �u
NO. STREET
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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Y p - Sanitary No.
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3 a Date G glirmit No
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o Application is hereby made to I q�ttyy of Cupertino r rtrit to install plumbing;
`o � pipes and/or fixtures listed on tli ,c?�C{3idt theyy4�C�7 and $ides to install said prices
I and/or fixtures in accordance with the provision's d�t'M1t' PI &" Code of the City of
<w Cupertino, and all other laws a>>licable thereto.
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LL Use of Premises00
OF CUPFRTi,n
aa Owner `I r 161 A1J2$14u Addres' 0g)w off' J&'e'a
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, By C �rhu,4@8�4' •. .9itC,
3 0 CONTRACTOR, AGENT G
.�p OSsL 625 Charles Street
— Phone�J San dear,; California 95112
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1` f State License 17637 ApprovedlzV^lli�Lit+. I �• "-'
a U PLUMBING INSPECTOR v
QJPFIXTURES I NUMBER MAIN DRAIN
UNI'T'S FEES UNITS FEES
Water Heater SO Size
Water Closet 3 O Material (f
Bath Tub O To Curb
Shower ,'- , pp To Prop. Line
Lavatories /"Og To Existing
Kitchen Sink r. Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine .Sj7 Size
Water Softener Material
Bar Sink To Main
Comb.Sink&Tray urb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size 1' 1 ,SO
Restaurant Sink Material g9
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storrs Drain Fee
SprinklerValve Water Sys.Fee 4-6
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee o
Total /13 Sp Total Fee