51016.1 f� / 1
'vems LOT NO.
NO. STREF.a'
cnro► cur"WPPLICATION FOR PLUMBING PERMIT
" a CITY OF CUPBRTINO
p JUN 1 1911
r o �p/��, Sanitary No.
3 U Dat Cj— IAZ Permit No S/V/(Ad
= w r� _ Pee $ oZ9.s0
" O Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i 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.
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w Use of Premises �—Sw��.. G e-
00
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o a Owner_�,f;?2 . /i�,r.�—C—� Address 7""
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By , Address /QD. .19oh (3—,24"
CONTRAC,# R, AGENT
3 m` Phone 6c�3 8 � �
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a � 'tate Licens�.�Q �5% O Approved I
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11, PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size 'l'" dOv
Water Closet Material. C
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
't hen in / Not Conn.
Dish Washer
Waste Dis osal
Wash Tra /' STORM DRAINAGE
Washin 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 11
s'o
Restaurant Sink Material
Sand TrapTOTAL FEES
Urinal Fixture Fee S�
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve, Cm�Fee,
5
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee