51189 (2)No. Street Lot No.
°
y g- A VN ITS
a ®� AP PPLICATION FOR PLUMBING PERMIT
W
CITY OF CUPERTINO
°PIAN 6 /97/ 7 Sanitary No. / /OS /3.j,
E Date 11 3 , 193Q
Permit No.511
1
3 CITY OF CUPERTINO Fee$ Sr^
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 in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
I
"co laws applicable thereto.
Use of Premises A -P-1 5
° Owner A�j ja=- C�tJ�T Cr
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=N BySk.t .jo5� rtt:.�1A-a„lira� rrJc..
3a Contractor, Agent
° Phone—'? --I5- 9044
-� State License "I -641&S
Address
Address 11.L QoC>EQ5 M1z, 5 J .
I
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l.Approved /
IIiffumbing Inspector ✓
Fu. couNT oC a y,
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size "
of
Water Closet
Material G I
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
4
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 I
ISQ
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
4%0,0
Area Drain
Main Drain Fee
of
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
5,
Relief Valve
I
Gfl� Fee
Vac Breaker
Skimmer
Filter
Permit Fee
1-00
Total
3 y,
Total Fee
S. `�0.�