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APRT���{j�1jjOR PLUMBING PERMIT
flptsEP 9 1968 CV F CUPERTINO
Sanitary No.
Lot No.
Date CITY OF CU S�Gtl� Permit No..t��
LLff�� �I ��������JJ Fee S
Application is hereby made to the City of Cupertino for a permit to install plumbing 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 Cupertino, and all other
laws applicable thereto.
Use of Premises 5 N SPR l'r l< Ii
Owner F0 N 6- Address a 1 c� % fA/NNir+ C7
Byu010FA SA R- S PR I NPiAXX Ce Address !;-0 k l+4"' -S-7.-
Contractor, Agent
Phone eY-3 P �/ G o
t, O
State License i 1 d 5-/ 1 Approved
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
N ("nnn
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 Trap
TOTAL FEES .
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee