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No. Street Lot No. S 1
o L
u ® rA'PPLICATION FOR PLUMBING PERMIT `l — a
CITY OF CUPERTINO Z C
o Z I /
1 (JAN 6 q71tj� Sanitary No. 7106 06 c -r,,
1 5►i s
�F Date I � 3 19 0 Permit No.
3 O±TY OF CUPERTINO Fee l3l S�
= 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
C in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
1 'E laws applicable thereto.
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m I Use of Premises nTS
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0 o Owner ki6; Lt7�1S'f. Go
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N Brea Jose_ nF�.t1�+Jtcot, xrJc.
3 Contractor, Agent
Phone
N� State License �-6 `f S
Address
Address! bbS QoLOaS NE- 5,J,
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lumbing Inspector
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FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size 4'
Water Closet
Material
Bath Tub
1V
To Curb
Shower
10
To Prop. Line
Lavatories
(
To Existin
Kitchen ink
1 Y
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
I To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size 1
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
o—,
Area Drain
Main Drain Fee
°9'
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
SD
Relief Valve
Gas Fee
os
Vac Breaker
Skimmer
Filter
Permit Fee 'L °i
Total
0
Total Fee
So