1403 (2) LOT NO. .
Fn TRE IT.,
APPLICATI FOR PLUMBING PERMIT
fF'E88 1962 OF CUPERTINO
4 DaIfQ{�Q�[3Tt111A 19�= Permit No. �7(/
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M Fee $
,y 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
V Cupertino, and all other laws applicable thereto.
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&' Use of Premises /,*.* VGr
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Owner/,iA"7.',va �%AP�:C;ir_r L7L. 'G�
Address_
gy /�n04' AlO/17. /uL Address 'A .a.9� �L
CONTRACTOR, AGENT
Phone rW Approve
�/V� PLUM ING INSPECTOR
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1 UNITS I FEES II ji JUNITS1 FEES
7,-/ -
Size 4
4L,ttz,—,,wot;urft, 3 1 Material 6
Bath—Tubsj To Curb,
Showers To Prop. Line
fa—vatorijs To Existin
kitchen S71iks—j N , nd
Dish
Washers
Waste Disposals t
Wash frays STORM DRAINAGE
Washing Machines 11 Size
Fa—g
shin
Water Softeners aterial r:
Bar Sinks To Main Drain
To—M To Curb
en a ni
brinking Fountain
Floor Drains WATERS
—Restaurant. Sinks Material d#Aiifj
Sand Traps TOTAL VEhb
-1�rinals _Fixture /�,510
Area Drains Main Drain Fee 6 o
Water Leaders Storm Drain h1ce
$prinkler Varves I I Water S s. Fee 00_
Permit Fee 0 C)—
FICITAL /A.,rAVTOTAL FEEtk
RE OR OF I TION
Tartial Rough
I
Complete.
"Rough Complete
F1 nal 7
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