51182lei%fin �� 60Y,,, LOT NO. v � /
NO. STREEILI-4.CG.
APPLICATION))FOR�PLUMBING PERMITlRyd—¢/eve
ITY �OF,-CU ILTI�NP
SN
/p �cSanitaG�/�jjpo. ?0'f r
Date 7�Cine.GLe� -2,6 96� fS68 Permit!_No
C! V n C'/ Fee $ 3. a O
Application is hereby made to IIIScity� ' u ertino for a permit to install plumbing
pipes and/or fixtures listed on the revers 4 pe J coP,jand agrees to install said prices
and/or fixtures in accordance with the provisions of fheblumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner ��t u Q �' Address/574/ "� <
By•Ioe AMAM,4Ri ,',r n-0. Address V.D• 4U&x /SO
Phone -296, --59(0
State License / Approved WILL! AM e. SEN"H
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS I FEES
UNITS FEES
Water Heater
I I Z.571
I Size
Water Closet
, p-p
Material ¢¢a-Zr
Bath Tub
/. SD
To Curb
Shower
4t
To Prop. Line
Lavatories
a.3,n
To Existing
Kitchen Sink
/ , SD
Not Conn.
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 I A,
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee SD
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee , Sa
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee OZ
Total
,j,s
Total Fee