Loading...
51129 LOT NO. Nn. STREET '-APPLIC-A*IION OR�PLUMBING PERMIT z < t✓ CITY OE� nUPERTINO z - rtI r� i r ° n 'JUU) 1 ( �96a sanitary No. a l , // 3 'a Date %nU��- (�� 196_ Permit No i a ` '1 i V lir �,l°EFTI�1(� Pee $—/ a'D O Applicatiori is hereby rn*ade Vo the C tyof�Cupertmo for a permit to install plumbing `o W pipes and/or fixtures listed 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. j Use of Premisesy '�`� • 0 0 p ' w ��i,��G / X/.Qi"✓�P.Qi Address4gZ?'9- LIiO ' 0 3 Owners _ si Z B y ��/� �-B Address J 0 � CONTRACTOR, AGLNT yy� - `0 Phone w z w w RLL . AppmvedWILLIAIVI D. ©ENGVICH a o State License. - 0 PLUMBING INSPECTOR FIXTURES NUMBER MAIN DRAIN UNITS FEES UNITS FEES Water Heater Size Water Closet Material Bath Tub To Curb Shower To Prop. Line „Lavatories To Existing Kitchen $ink Not Conn. Dish Washer Sewer Box Waste Disposal Wash Tray STORM DRAINAGE Washing Machine Size Water Softener Material Bar Sink To Main Drain Comb.Sink&Tray To Curb Dental Unit Drinkin Fountain Floor Drain WATER SYSTEM Hopper Size Restaurant Sink Material Sand Trap TOTAL FEES Urinal Fixture Fee d-o Area Drain Main Drain Fee Water Leader Storm Drain Fee Sprinkler Valve Water Sys.Fee Relief Valve / Gas Fee 4)7 Vac Breaker Skimmer / Filter / Permit Fee Total Z O—V Total Fee 3�