51192.2 (3)) 0I 6� * I R -A N Dy I A N\ LOT NO
NO. STREET
N FOR PLUMBING PERMIT
D T
Z T OF CUPPRTINO
Z
xo 111 7 19tp� Permit No Sanitary
o Uate
1 i
¢ .f'/i 9.2 . �.
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3`
U PERTINO Pee $ �=
4 C���I �� Pio
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ica r n is i reby made to the City of Cupertino for a permit to install plumbing
0 < 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
a w Cupertino, and all other laws applicable thereto.
w x
� r
Use of Premises
0 0 �— O
oa Owner Address
ny l�}Ii Ve N L A N e� ,CAp i "Czj
" a, /"-Y'3-S'
CONTRACTOR, GENT
3r SAR,4Td t;P $•U NN% '�-C
- � Phone
¢a a l� -Approvedo State Li —qQ'
— U 2 PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
Units Fees lUnits Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Pro . Line
Lavatories
To Existing
Kitchen Sink
N nn.
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
Restaurant Sink
Material
Sand Tra
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee aA Ce
Total
Total Fee