51181 (3)E
WS
LOT NO. Gi 9
NO. STREET
APPLICATION FOR PLUMBING PERMIT
jC'!$Y OF CUPERTINO
Sanitary No.
Date I Permit No le"4'1
L 40 Pee $�. S'D
Applicp�of ;; hQp±y made to the City of Cupertino for a permit to install plumbing
pipes an to hst'���'C¢� side hereof, and agrees to install said rices
and/or fixtures in accordance wi h e p'lovisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner_
ff // CONTRACTOK,AGENT
Phone o O
State License
PJ
Addres
4.
Address �- • oo''17
leMBING INSPECTOR
FIXTURES I NUMBER MAIN DRAIN
UNITS I FEES UNITS I FE ES
Shower
To Pro . Line
LavatoriesS
°
To Existin
Kitchen Sink
/
/ S°
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
/
-
Wash Tray
STORM DRAINAGE
Washing Machine
J
.So
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & TrayTo
Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
' Hopper
Size "
1Q
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee K�
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee / ,So
Relief Valve
Vac Breaker
Permit Fee f aU
Total /� • Total Fee •jl s—U