51177.1LOT NO.
NO. T �{♦. / / /�
Nob P 'TION FOR PLUMBING PERMIT C
a Cf/�Pc Q CITY OF CUPPRTINO
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x o , � �� Sanitary iA'u.
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0 a ? a ej R2'S176�� Permit No. / / -7-2,
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02.3. S o
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� Appli atois hereby made to the City of Cupertino for a permit to install plumbing
`o 1- pipe33,� or fixtures listed on the reverse side hereof, and agrees to install said prices
and}Cyl' fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
00 Use Of Premises
o J Owned�� T Address
J p DY�����_ `ii�k�s«,,.Address�CL�ifiO,
3 F CONTRACTOR, AGENT 7
Phone -.3
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p a -I1-70 (� ,
a o State License_ ��GS 7 Approved_
U tq PLUMB[t•{C' INSPECTOR /
# 16/2
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
—7-
Material
Bath Tub
/
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
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
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Stom Drain
Sprinkler System
Water Sys. Fee
Relief Valve
Gaq Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
Total Fee ,