51182LOT NO. IF
NO. STREET
APPLICATION�OIPLUMBING PERMITA--°` Ve-&
z < I Y 0 �•�UPFRTY40
s �anit5r No. /n.O
o FC
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R W //Bik r+c-�i-t--° %G 196 P" 490 Per 7
o < Date it No 5 //
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0 8 �C�l' Fee $ Z k', O ()
o Application is hereby made to the-Gf5 of Cupertino 'for a permit to install plumbing
o r pipes and/or fixtures listed on the reverse.�ii�dY�ttereof, and agrees to install said prices
> a and/or fixtures in accordance with the provisionsldf the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w x -
0 LL Use of Premises !-� i
00
>moo. P�/reGcGKQac,
o a Owner
By Jae Amaral PlumM ns Address O
CONTRACTO1./ ne^- �
3 m Phone�Q — 3 y[> 3
w z
u Y State License 1%s"'Z�< Approved-WILLIAM 2`1122"
ao
— U� PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS I FEF,S UNPCS FEES
Shower _
„SD
To Prop. Line
Lavatories
, 0�
To Existing
Kitchen Sink
„57
Not Conn. '
Dish Washer
Sewer Box ..
Waste Disposal
-
Wash Tray
STORM DRAINAGE
Washing Machine /
/.SD
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb -.
DrinkinFountain
Floor Drain WATER SYSTEM
Hopper Size I1" I
Area Drain Main Drain Fee
Water Leader Storm Drain Fee ---�
Permit Fee
Total /.Z /rd-� Total Fee