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NO. STREEI'
APPLICATION FOR PLUMBING PERMIT
CITt-mitary No. cGF CUPERTINO
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Date kGcr' a1-24
C 196— Permit No
9
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1968 1 Fee S r% .S%%
Application is hemby.trtade to the City of Cupertino for a permit to install plumbing
pipes and/or fixturesUiste�o�tfie SAV.USside hereof, and agrees to install said prices
and/or fixtures in accordance with 0jyr�l1i UsIpAthe Plumbing Code of the City of
Cupertino, and all other laws appliic/abble—t er'tb�Vll
Use of Premises.i//����-�-�-z�
Ownera6� C a Address1-SO6l'
Byhe Amaral Pliphmv InC AddressP_o. /y�-v iso
CONTRACTOR, A NT 4.0 L' AXL.A /
Phone
State License
Approved IRrn I 'An*
X
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
/So
Size
Water Closet
/.,$'p
Material
Bath Tub
3, 0z)
To Curb
Shower
/ s�
To Prop. Line 1/
Lavatories
,6D
To Existing
Kitchen ink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Q
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 SinkMaterial
Sand Trap
TOTAL FEES
Urinal
Fixture Fee . 1—e
Area Drain
Main Drain Fee S. r�U
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee , SQ
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee D--D
Total
p
/,3 A/'SQ
Total Fee