51181N i
W Z
I�/y�y/ "' LOT NO.
NO. STRF.E.T
/Y3 Y
APPPLICA ION FOR PLUMBING PERMIT
O )OF CUPERTINO ([/
Sanitary No. '5-3/
/
OR)
Date i q . 6-7 Permit No .i-//
Pee $ aG _ S'd
AG}iF' ortr"�he �}� nttq•(c�Ith ity of Cupertino for a permit to install plumbing
pipes add or Lure h e jJI V'1{ W,erse 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 /J -15,7110
C • 711n
Owner�ZZ 02id..r -! Address
By1 ��� /,L�� Address/
CONTRACTOR, AGENT �j
Phone.7✓-�I
State License.
X PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Water Heater / /,J'+ Size
Water Closet
,$
-/J7 Material P . r,
Bath Tub
/
/ J"o To Curb
Shower
/
/.,j -b To Prop. Line
Lavatories
3
To Exi sting
Kitchen Sink
I Not Conn.
Dish Washer
/
Sewer Box
Waste Disposal
/
Wash Tray
STORM DRAINAGE
Washing Machine
/ „ry Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Fountain
Floor Drain �� WATER SYSTEM
Hopper Size /';
Area Drain
Main Drain Fee S Gd
Water Leader
Storm inFee
Sprinkler Valve
Water Sys. Fee /.J?
Relief Valve 1
11 Gas Fee I..r;,
■ Vac Breaker
'JKlnlmer
Filter
Permit Fee Y•oU
Total ZZ EG,fvjjTotal Fee