51179LOT NO.
NO. SnEF.a'
APPLICATION FOR PLUMBING PERMIT
CITY OF
Date ®OF?r I;y
CUPERTINO
Sanitary No.
Permit No. / / 7 `/
Nuv 10 IJbt "k Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
P ipes ygsl qy fi�qures fd� Ejrg�rgvPIse side hereof, and agrees to install said prices
and /o i 'res n-acc r n i t provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Phone ���3� �L?
State License %l �s%Z
(J -
WILLIAM D. GENEVICH
Approved
,,/ PLUMBING INSPECTOR
FIXTURES I NUMBER II MAIN DRAIN
UNITS1 FEES 11 UNITSIF
Water Closet l�-7 11 Material 1/�/
Shower I/ I II To ProD. Line I v I I
Kitchen §ink Not Conn.
Dish Washer Sewer Box
Waste
Size
Material
Comb.Sink & Tray I 1 11 To Curb
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 Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Filter
Total Fee