Plumbing Application 19O4 I WHE0 I VAJ e LOT NO.
NO. STREET
APP
LICATt � �i PERMIT
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f 0 BSEP 9 19C4nit '`' No.
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0 a Date 196 Permit No
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0 Application is hereby made'to the ay o upertmo for a permit to install plumbing
o r pipes and/or fixtures listed on the reverse side hereof, 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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LL Use of Premises
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oa Owner—C, Addres'.
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3 O pCONTRACTOR, AGEN$25 Charles Street
— 0 Phone4t--oSS?'o San Jose California 95112
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ao) State License 1 7/5-37 Approved sC
PLUMBING INSPECTOR
ba FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater %•SO Size '/ S.CL7
Water Closet .SO Material �•L
Bath Tub 45D 'I'o Curb
Shower Ij5O To Prop. Line
Lavatories To Existing
Kitchen Sink z-,e—O Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine O Size
Water Softener Material
Bar Sink To Mai am
Comb.Sink&Tray urb
Dental Unit
Drinking Fountain
Floor Drain WR'I'ER SYS'T'EM
Hopper Size /•
Restaurant Sink Materially
Sand Trap TOTAL FEES
Urinal Fixture Fee O
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water S s.Fee
Relief Valve I Gas Fee p
Vac Breaker
Skimmer
Fi Iter
Permit Fee p
Total lzliL JX4f)o Total Fee