NO PERMIT NUMBER �V I W)4PA17SDN LOTNO. SI
NO. STItEE.i'
APPLICATION FOR PLUMBING PERMIT
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CITY OP CUPERTINO
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Sanitary 1\U.
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0 a Date 196 Q mit No
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e S0Application is hereby made tity of Cupertino for Permit to install plumbing
o r pipes and/or fixtures listed on S@P1e9hgt�a an i�recs to install said prices
I and/or fixtures in accordance wprovisions of t P rzibing Code of the City of
a
in
Cupertino, and all other laws applicable thereto.
„ Use of Premises • CITY OF CUPERTINO
00
" Address
5 3 Owner
z_j eogo CeWLa CD., 9n�
zBy $f0ress
O CONTRACTOR, AGEN
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- Phon4a-q -ac,– tl San loser California 95112
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State License 171537 Approved
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0 -y-PLUMBING INSPECTOR
Vj1p FIXTURES I NUMBER MAIN URAIN
UNITS24,C0
UNITS FETES
Water Ile Iter Size G $
Water Closet Material �•,L
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
Comb.Sink&Tray urb
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 Stom Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee OD
Total 1,3 &-5ej Total Fee