51075.3 (5) 6) 1 /0 —e,
_, (,� LOT NO,
NO. STI EE.T
APPLICATION FOR PLUMBING PERMIT
" d CITY OF CUPERTINO
r o Sanitary No.
LL y�
o �'''��i Date �\\r��/ 196 Permit No '�/03�7
/��� ��s/ 1(" y Pee $ .Y`�
w Appl ci ation�lvhe ! made to the City of Cupertino for a permit to install plumbing
'o �ptT and/or fixturc4,lis'ted on the reverse side hereof, and agrees to install said prices
an fi>gires in aScdrdance with the provisions of the Plumbing Code of the City of
U) Cupertino, and alltoFher laws applicable thereto.
LL Use ofijPrE{rti es
00 Re � 11aJ
r 3 Owner r�al�/�PJi Address
OJ
z By Z—" Address x Z9/,
CONTRACrOA, AGENT
3 N Phone
w z —�
u f State License 1�1 7 Approved WILLIAM D.
a o
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen ink 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
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stonn Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker _
Skimmer
Filter
7
Permit Fee o2 `�—
Total Total Fee