51181 (3)LOT NO.
NO. STREF.I'
�OAPPLICrATION FOR PLUMBING PERMIT
k C11-UY OF CUPERTINO
Sanitary No. J 1
Date (n Cf C L 196� Permit No
Fee $ a .3..SZ%
Aplic o„ h byQn�Ii3�Ttbj�hq City of Cupertino for a permit to install plumbing
pipesJ'n or Ixtur h33te n the reverse side hereof, and agrees to install said rices
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, 7� a
Owner /TZ r/ e5n(� Address
By 10"Z Address
ONTRACTOA, AGENT
Phone/�%— B >'� 6)
State License 5- 3 03 `7--�
ApproveciNILLIAM D. SEI'4 `'CH
PLUMBING INSPECTOR
h
Permit b'ee t
Total ry /3,S 0 Total Fee
1
FIXTURES
NUMBER
MAIN DRAIN
UNITS
FEES
UNITS FEES
Water Fleater
/,J�144
Size
Water Closet
'7/
3-rD
Material C it
Bath 'rub
•J1
To Curb
Shower
/
/,JP
To Prop. Line
Lavatories
3,�d
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/
d
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 ,1 A0
Water Leader
Storm Drain Fee
Sprinkler Valve
Rater Sys. Fee /.So
Relief Valve
Gas Fee /, .ro
Permit b'ee t
Total ry /3,S 0 Total Fee
1