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E APPLICATION FOR PLUMBING PERMIT r"p h 197M
CITY OF CUPERTINO 16�5
0
U 'N'.
Sanitary No. _ I'PrV Dr,
x Date "� a-1— , 19TL Permit No 5l oi5' a
3 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
c-E laws applicable thereto.
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A � Use of Premises f- rtL-t 1A f7o J A S'i'Ot2t
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° Owner�0IAd02u.fiS a. (,jLL-%gJ Address
T �1k11� 2 C-TTC > Kms.•
Address , ` _ •r• ,tai_=
3 .5 Contractor,Agent
Phone W
State License 2$q Cx��--- Approve 1-- I
�lumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
j
Healer Size
Closet D Material C• :
Tub -To-Curb'
er To•Pro ..Linc
ories To Existing
en in -N G n-
Washer 50
Disposal
Tra STORM DRAINAGE
n Machine �iie�-
Softener vial
Bar Sink To-Main-Drain
Comb.Sink&Tray 'Z 10 'Fla6 Fb-
Dental Unit
Drinking Fountain
Floor Drain I Tr6lWATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader -D in^Fe
Sprinkler System Water Sys. Fee Q
Re]ief Valve GmFee t t
Vac Breaker
Skimmer
Filter
Sa
Permit Fee ?• E D
Total Total Fee 2