51181i3 T I LOT NO. o:2
NO. STREET ;OL7lu y
APPLICA ION FOR PLUMBING PERMIT
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�--M M� [�� YOF CUPERTINO
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y° 619 7 �1 sanitary No'/� , 196 Permit No
° < Date
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W LL ('�T�/ (n�C /(��' I C[ppTT''nnI�(� Fee 8 � 3.J
° Appltcatiohlls hPAPpa4TIN1hf City of Cupertino for a permit to install plumbing
o r 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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a ~ Use of PremisesC
00 �j _ s
3 Owners z - �/��� Address
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< o By r' LQl Address /1lid -/ 7 72z1t-+/E
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CONTRACTOR,AGENT
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0 a Z3 0 �j.SY VA1-LIA67 D. E. ENMVICH
a o State License f Approved
1\ - V & PLUMBING INSPECTOR /
FIXTURES NUMBER II MAIN DRAIN
UNITS I FEES , UNITS I FEES
el
Shower
l
To Prop. Line
Lavatories
y
To Existin
Kitchen ink
/
Not Conn.
Dish Washer
/
Sewer Box
Waste Disposal
/
Wash Tray
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 /
Restaurant Sink
Material G
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
Skimmer.
Filter
Permit Fee Z•
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Total
/3. s
Total Fee 02, 3
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