51198LOT No.
NO ! STREET-. -
?UL
P LICAT ON ` OR PLUMBING PERMIT
a �a
z _ CITY OF CUPERTINO,0 .9
Sanitary No.
�LL
0a Date C , 11196 /_� Permit No S // i-
3 " • I,ITVUf:CI�PERTIn+�
f ,Fee
9 Applicationls hereby made to the.City-of Cupertino for a permit to install plumbing
`oma pipes and/or fixtures listed on.the reverse side hereof, and agrees to install said 'prices
r . and/or -fixtures in accordance with the provisions of the Plumbing Code 6f the City of
Z w . Cupertino, and -all other law's applicable thereto.
I'LL Use of Premises. '
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3 Owner Address
A.z g'. r //C/LG7G =' fJL 1, lr/f/b°ij Address i/.5-ttir.i.c,v2 !-wl
3 0 y CONTRACTOR. AGENT.
— Phone
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u °s State License -�' f��. G o :Y Approved (i" -
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PLUMBING
INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Ileater
Size
Water Closet
Material tit3
Bath 'Cub
To Curb
Shower
To Prop. Line
Lavatories)
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
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
Size
Restaurant Sink
Material I G..t;(,
Sand Trap
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Stonn Drain Fee
Sprinkler Valve
I Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee O�
Total
/ r
'Total Fee 6 , 0 0