51000 'le Gw / 4 / Lf/� Y - LOT NO. -- -
Nn. �STIIEF.T —�
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APA A N FOR PLUMBING PERMIT
z ® F CUPERTINO
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r o Sanitary No.
0 LL /�J b 3 7 'F/'6&0
0 llate Permit No
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w 0 - Fee $._
10 ,�1,{
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I s eb of Cu rtino for permit to install Plumbing
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0 a pipes an�/or fiats LiSfEdtd+�k��1�}se side herrn[, and agrees to install said prices
r I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
00
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0 a Owner Address
J z //—�>!.�Gfia�—� Address
3 r CONTRACTOR, AGENT
- 0 Phone .�53- 06/�
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0 Y State Licensed—Z� C` 3,6 Approved
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U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prom 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.S ink&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 Stom Drgin Fee
Sprinkler System Water Sys. Fee
Relief Vaf�� Gas Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee i