51181I
LOT NO.
NO. STREET
APP.L-ICATION FOR PLUMBING PERMIT
J [i r_CITY OF CUPERTINO
—] 1 li Sanitary No.PIP3
1
D..f, ,
I_rr.A 7 196/ Permit No f 11G11
Fee $ o? -3•
r'3plicatibq is�?ejd _@fll(' ,'lhe City of Cupertino for a permit to install plumbing
pipes 3nd�r fixttirest It�li t�d4th'e 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 S•
Owner DTZ Address
B
--z:> G �,L�� 2� 6!, Address iy6a —i7 T a s
CONTRACTOR, AGENT a�
Phone i)
State License '3 O � Y
Approved VUILUAM17 D. 9ENE-ytrH
PLUMBING INSPECTOR /
1
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater % /fv Size
Water Closet 'r ea Material (` .Z
Bath Tub
/
To Curb
Shower
/
vy To Prop. Line
Lavatories
Y
-.00 To Existing
Kitchen ink
Not Conn.
Dish Washer
/
/.J o Sewer Box
Waste Disposal
/
Wash Tray
STORM DRAINAGE
Washing Machine
/, G Size
Water Softener
- Material
Bar Sink
To Main Drain
Comb.$ink & Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper .
Size /
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee 3 Sv
Area Drain
Main Drain Fee f e, o
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /,fa
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee rL. p o
ITotal I / 1/3,S7011 Total Fee Ia