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No. STREET
APX�ICATION FOR PLUMBING PERMIT
i a �� G��t CITY OF CUPERTINO
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0 a Date — 3 O — 19�1 Permit No. �%t f i'� 7
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0 Applicltion 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
s 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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LL Use of Premises
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3 Owner HO R 2 o D 1 A/ , W . Address S-4 r,
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� c By /} Cc PLf36 SE/t Irl Cc LV 4u dress •396 PEa Rv�atiT CONTRACTOR, AGENT
AGENT
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- Phone 9 -7- ,?107
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o o ,State License Z 3 77O F Approved W[LLIAM D. BLNEVICH
- U PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
Lavatories To Ex' tin
Kitchen Sink
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 Tra TOTAL FEES
Urinal Fixture Fee
rea Drain Main Drain Fee
W e e Storm min Fec
Sprinkler System Water Sys.Fee
Relief Valve I F�,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 2- 0
Total I Total Fee 3"3-0—