51189IC( 0 VE LI-R-KtA! D
No. Street Lot No. 94
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N
)JAPPUI�ATION FOR PLUMBING PERMIT z —E& u...ri
E CITY OF CUPERTINO �Z— C UN'Ts
° 7
Sanitary No. ! / �9 B.F.
r1AN 6 ! �/
E Date I , 1910 Permit No. S II
3 C,!TY OF CUPERTINO Fee $ 1OI Si
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
c 'c laws applicable thereto.
A o
m � Use of Premises
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° Owner AV pLW CG t,35T in Address
ti BYSA.J .J OSG.- t-tFLq-tt�J lcht ��JC. Address Ibbs PtC�F2s AJE 5;-1
3 Contractor, Agent
u`o Phone 2�S'go�i�
State License 26`i 1$S�Approved
jT (/Plumbing Inspector 4�
FIXT-RC'
CouNr Oe. 9. -J,
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size H'1 1
S
Water Closet
Material C,1.
Bath Tub
8
To Curb
Shower
L
To Prop. Line
Lavatories
To Existing
Kitchen in
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
4
To Main Drain
Comb.S ink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size 1l
Restaurant Sink
Material
SandTrap
TOTAL FEES
Urinal
Fixture Fee 271°
Area Drain
Main Drain Fee
s i
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
o
Relief Valve
11 Gas Fee,1
y0,9
Vac Breaker
Skimmer
Filter
Permit Fee
Total
S
Total Fee
1015