51125 /O __�a/ LOT NO. �
N Q � � BPL TION FOR PLUMBING PERMIT
"0- CITY OF CIJPFRTINO
sanitary No.
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o a Date 19f>>d Permit No
3�
= LL . peen 3r �o i
Application is hereby made to the City, of Cupertino for a permit to install plumbing
`o a, 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
a w Cupertino, and all other Taws applicable therrf�`� J
` ~ Use of Premises � V� I �AT RkE��_
JLL
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3 Ownerr r O s Address 33✓�
o J B �ALWIN PLUMBING CO. Address
3
0 y— 25/-t(*to TOR. cerLTD ROAD
`m Phone 3EDWOC)n r'tTvr GALIF. ^'S-0714F
w z ,J
a f State License� 5 5 Appe� ��
8
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PLUMBING INSPECTOR J
FIXTURES NUMBER MAIN DRAIN
Units' Fees Unitsj Fees
Water Heaters o I Size
Water ClosetMaterial
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existin
Itchen 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 Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief V Caq Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee 3 5D
ld-/ 7 "?0