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®F `�""' 1 t1A I� TION FOR PLUMBING PERMIT
FG��'� "®' °�-'EE U CITY OF CUPERTINO
,j - C UNITl
,IJA f /(J7' Sanitary No. 7/00 IF.
Date , 19aQ Permit No. 74
CITY OF UPERTINO Fee $ $b
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.
Use of Premises .pc r t rj
Owner nvEQL Cnw1ST• �.
By ) 4Fni SOSL X1 iHt.11 AL i AIC -
Contractor, Agent
Phone Z1 S - 9 1)4�
State License '-j-(.14 LgS
Address
Address I AL'S KL(.EZS AvC SJ
Approved
- L Plumbing Inspector
r 1A T uar CoV 4+7
Oe-
KFIXTURES
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size
$
Water Closet
t7-
Material
Bath Tub
To Curb
Shower
+E
To Prop. Line
Lavatories
t"t'
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
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
ei
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Re] qcf Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee "Y?�
Total
Total Fee
to So