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No. �Jryet Lot No.
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APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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r Sanitary No.
E Date p2 — ;l 2 " , 1991 Permit No. /5•
o Fee S rJ�
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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
0 ; in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
9 laws applicable thereto.
A ro Use of Premises
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Owner r,.)oteo (P )LL Snwf Address
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am ByDe TE �LOmnuL.1 Address d/16�t�'7Y16= /�t�.
3 Z Contractor,Agent
Phone �7 1— 814 3
State License CI 0 C 7 Approved
14"F- (Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units I Fees Units Fees
Water Heater Size5d,
Water Closet 3.0 0 Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories 6 To Existing
Kitchen ink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper 11 Size JL4 cod, 1
Restaurant Sink =Fixture
D
Sand TrapEES
Urinal Area Drain Water Leader eSprinkler System
Relief Valye 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee A
Total Total Fee Q