51234 (2) 20090 Rodrigues NOT NO, R
No. STREEI' L
CITY OF CUPERTINO `I-A 6 —D
z a crrr of NP`"""OAPPLICATION FOR PLUMBING PERMIT
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Om JUN 8 1971 Sanitary No.
o LL )ate May 2�i 19 Z Permit No S/2 3 �
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A I D
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To
Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
a 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
<w Cupertino, and all other laws applicable thereto.
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w Use of Premises Apartments
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3 Owner Jerome White Address Ial59 SO_ Blaney
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z By San Jose Mechanicah?ns; Address 1665 Rogers Ave_ S_J_
0 CONTRACTOR, AGENT
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— 0 Phone 275-9OU
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0 f State License 2285 A r ed
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NUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / /.Se Size y" Soo
Water Closet / -j ye Material 6/
Bath Tub /o / .o To Curb
Shower L 5,6ol To Prue. Line
Lavatories /G gs/vol To Existing
Kitchen Sink ✓D IX oe 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
r ,
Restaurant Sink Material ria.✓
Sand Trap TOTAL FEES
Urinal Fixture Fee 88:.TU
Area Drain Main Drain Fee S
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee Sd
Refief Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .Ron
Total ffsb Total Fee ,s0