NO PERMIT NUMBER / / U "G myN DAR, LOT NO.
NO. STRE.E.I'
APPLICATION FOR PLUMBING PERMIT
W4 CITY OF CUPERTINO
z i
w
x a q Sanitary No.
g / 196f Permit No
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30 Date LL ,/p'p ee S S!D'
° Application is hereby made to the �' r�rt�' er o install plumbing
'o pipes and/or fixtures listed on the r sq Ide hereof, an r Install said prices
r : and/or fixtures in accordance with th rb qas pf9thLUM de of the City of
<w Cupertino, and all other laws applicable thereto.
w Use of Premises kas oily //fi�r
0 o y� I i77 Into
zJ Owner C• Ii. IcI�N a. i lq Address, 'V �'• ^
z By l�llt �-�/ 41• Address
° ppCONTRACTOR, AGENT v
3 `m Phonea�6�OSSG
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u F State License��5 3� Approved -
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tl' — U PLUMBING INSPECTOR ✓
08 FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size " 5.00
Water Closet sZ 3.00 Material G.
Bath Tub / ).,o To Curb
Shower / /,—<V To Prop. Line
Lavatories 3 SU To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine /SD Size
Water Softener Material
Bar Sink To M ' ain
Comb.Sink&Tray Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size f"
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee DD
Sprinkler Valve Water Sys.Fee -�
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 06
Total JO Soo Total Fee D0