51189'-4. LOT NO.
NO. STRF.F.a'
CITY
qfY GP CW�TNO
fav 24 gP�LICATION
OF CUPERTINO
FOR 'PLUMBING PERMIT
Date P 19 1
Sanitary No.
Permit No .i%/
Pee $ /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 in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises &f9wXLER Sys7EM�
Owne/I 544"L
13
�CONTRACTOR, AGENT
i
Phone � 0C— 7mj
State License.
Address
flf.I/ //ifG/•
Approved 67
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.S ink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relqef Valve
Gas Fee
Vac Breaker
A.
Skimmer
Filter
Pool $weeper
"Fees—
Total