511674�/A I PC, �'? ae"*- 0-S Q� . LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
u d -'CITY OF CUPERTINO
4Sanitary No.
'0 r9 //` �1�jL�l �j
0 U Date "F• y 0-- t1 , )19r_7
Permit No s� �O�
Via!/6�,� 2 �J�� _; Pee$ 3/
° Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes anil,�pr �xtures li a {��tjlelyet�erse side hereof, and agrees to install said prices
> and/or r(fi``xtures i`�Ifacco d[� [y�all �tFiet}sros-isions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
a Use of Premises 6 Q_Ao e
Oo /' % /%� '/ /
oa Owner 6— `(:rc_LU Address �����i /4'(a U2�'�1.PS4
z Dy — •� 4 01- Address Cvesce,.'7� Ic
° COIVTRAC AGENT
— m Phone
w Z
< o State License g Approve /
—0 PLUMBING INSPECTOR 1/
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Waterlfeater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Troy
STORM DRAINAGE
Washing Machine
Sire
Water Softener
.� Material
Bar Sink
To Main Drain
Comb.Sink&Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
fixture Fee
Area Drain
Main Drain Fee
Water Leader
Stom Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
'Intal
11 Total Fee