51182/✓�/✓ I LOT NO.
NO. STREET
APPLICATIO�FOR.PLUMBING PERMIV�" �Dz
i dCITY aCUPERTINO
rs
mv earY
No. 1,,0,6-1
t3�o LL ��Pmit No S//f20 a Date 196��
3�
196 Eee $ ,�If o(9
LL° Application is hereby made to the eC�%tyy,of Cupertm6jf6r a permit to install plumbing
o pipes and/or fixtures listed on the rever;e Side hereof; and agrees to Install said prices
> a and/or fixtures in accordance with the provis`,iblrs ,of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable theretol
wi
iLGQc.Ea�r
o Q Use of Premises yJ�-
o< Owner-A24,06 dOLu,EsCc-.r n. �d AddressS1%7/.� �
ByJoe Amaral Plumhin c AddressP.o - /� iso
CONTRACTOR, AGEN
- 0 Phon ,=l " ,y (P •a /cac✓r�'�, 1..�-���°`�
w Z
o State License
Approved
WILLIAM D. 13ENEVICH
y PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS I FEES
UNITS FEES
Water Ileater
I Asv
I Size I
e1v
Water Closet
,SO
Material
Bath Tub
/ "D
To Curb
Shower
/' .SD
To Prop. Line
Lavatories
,"
To Existin
Kitchen Sink
„S-1)
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
s -D
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
I WATER SYS'T'EM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Ivk, a-0
Area Thain
Main Thain Fee
S ov
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
O -p
Total
l ,g
Total Fee o
")