51189 (2)- --
No. Street Lot No. S S
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n Z EZ UN IT3
m ® [CATION FOR PLUMBING PERMIT 2 - C oti yrs
E E — CITY OF CUPERTINO Z - O V.,,r s
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U 1.�AN 6 Iq7Sanitary No. %1 ID a, F.
Y Date 190 Permit No. Su%
3 CITY OF Fee $ S
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
o Itin accordance.ivith the provisions of the Plumbing Code of the City of Cupertino, and all other
.4 laws applicable* thereto.
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m V . Use of Premises •• W-% S
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° Owner�IEQ��f.IS-r, Co Address
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By SAvj •..%oSHECNt4.J IGM- ItJC. Addresslfn6S 24c'ers ANN 5'-l•
3 Lam. Contractor, Agent
° Phone
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C State License •x614 1$ S ApprovgQ`
`C\ lambing Inspector
FIXTURE
CoQT'
aAL �.�.
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size 4.1 1
Water Closet
Material 6.1.
Bath Tub
To Curb
Shower
4
To Prop. Line
Lavatories
S
To Existin ✓
Kitchen Sink
N t 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 1 y
Restaurant Sink
Material CoVeriZ
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
.41300
Area Drain
Main Drain Fee
S °�
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
co
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gFilter
Permit Fee
Zon31..
Total Fee
LS 50