51192.1a0
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LOT NO. J
\NoirF.L° I
APPLICATION FOR PLUMBING PERMIT
l i �1QV Ni I��O CITY OF CUPERTINO
1
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Date -•✓1/D I/:.79' 1961E
Sanitary NU.
Permit No
Pee $2.6. S-%
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises /�
✓NN �✓9
Own/er'C T• / Address --(W%. A4 lea Ts1iL),I;t
By( r�7V7A 6 JCcA - cDi///C AddressGo� C�i9Cl67 J/
CONTRACTOR,AGENT fHN J0 -f
Phone -7-97 - 0,1—, z
State License X 171 f3 % Approved
XPLUMBING INSPECTOR
FIXTURES
F
NUMBER
MAIN DRAIN
UNI'T'S FEES
UNITS FEES
Water Heater
• TU
Size f �o
Water Closet
3 q- J'0
Material C.T
Bath Tub
/. J o
To Curb
Shower
. J-
To Prop.. Line
Lavatories
41e •00
To Existing
Kitchen Sink
/ /. Jb
Not an.
Dish Washer
Sewer Box
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/f• / /TU
Restaurant Sink
Material L
Sand Trap
TOTAL. FEES
Urinal
Fixture Fee / . J'O
Area Drain
Main Drain Fee S.00
Water Leader
Storm Drain Fee
Sprinkler Valve
D
Water Sys. Fee • FD—
F Total I IlG„ SO 11 Total Fee I'✓6 s 0-1