51182LOT NOI'
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z d CUPERTINO
r o Sanitary No, l0 yy
3 < Date �Tk�+� U—� 196— Permit Nohh
w U - ,y IJ68 J aee $—,,2S', 6
�4
a w Application is.hVeby made to the City of Cupertino for a permit to install plumbing
01 pipes and/or �ritures I ed c)fl trg�'��gg ase side hereof, and agrees to install said prices
i < and fixtures in accordaI cet �t�l.lB� pr&islons of the Plumbing Code of the City of
a w Cupertino, and all
other laws applicable tWeto.
0 o Use of Prrreemises/le�2epd,,�n� C
oa Owner lLL_c� U Y Address /F?, I -Q �Lu�
By..lne Amaral Plnmhigjc Address t iso
H CONTRACTOR, A NT /tJJ
3�
-0 Phone a9/, '34L.3
wZ
R a
a State LicenseApproved ig_nr_n."5o
^�^
_Q / PLUMBING INSPECTOR
c/ V,
FIXTURES
NUMBER
MAIN DRAIN
UNITS
FEES
UNITS FEES
Water heater
A s-6
Size
"
Water Closet
J
V,SO
Material
eni
Bath Tub
/
.SO
To Curb
Shower
/
, SO
To Prop.t�
Lavatories
O"D
Kitchen ink
/
SO
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
,SO
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
11
WATER SYSTEM
Hopper
Size
Restaurant Sink
_
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
IF,n
Area Dain
Main Dain Fee
So -d
Water Leader
Storm Dain Fee
Sprinkler Valve
Water S .. Fee
„j D
Relief Valve
I Gas Fee
,s'
Vac Breaker
Skimmer
Filter
Permit Fee
Total
z
b? OZ I
I Total Fee
o ,