51192 (2)MUTI
iuiki'a#r CA LOT NO.
NO. STREET
APPLICATION FOR PLUMBING
" a CITY OF CUPERTINO
wS0i ! -
s.0, Sanitary No
PERMIT
y
¢ I4i i
3 U [Ja - 3 _�—, 196-F Permit No 4—//9 2�
w n �,� Fee $ o? J J c/
�o
� Application is hereby made to the City of Cupertino for a permit to install plumbing
`o 1- 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 of the City of
¢ w Cupertino, and all other laws applicable thereto.
., Use of Premises !\ ertr S .
00 // ,I
oa Owner_l..06,A— pp6 5 Address
z
z By F
O
3 9�
— Phone g2 s Street
W w San Jose, California 311
a ¢ A
a o State License 17163;R
_U
o 5 io
VALLIAM D. £_`MICH
PLUMBING tNSPEQ'OR b-
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
/•.SZ)
Size I �
Water Closet
.00
Material C,
Bath Tub
I.-Sro
To Curb
Shower
,S
To Prop. Line
Lavatories
.3 4,.<'
To Existing
Kitchen Sink
Q
I Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Troy
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tra
To Cu
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size I 1 'I /�
Restaurant Sink
Material —"C,( f
Sand Trap
TOTAL FEES
Urinal
Fixture Fee IS -6o
Area Drain
Main Drain Fee
Water Leader
Storm Drein Fee
Sprinkler Valve
Water s. Fee
Relief Valve
Gas Fee / .41
Breaker
Filter
Permit Fee
Total Fee