51192/993 8 17�&k j'6 1Y / ` T LUT
NO. STREET
APPLICATION FOR PLUMBING PERMIT
V)Iie
CITY OF CUPF:RTINO
zYSanitar NuU 1 t0�o 3/� 196T Permit No.
3U
i LL Fee S '2 3 <�
r 0 Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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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,. Use of Premises
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> r 3 Owner Address
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z By SOMAR 1,9JO•1 Qiee Address
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30 `b Ca3"629�—o'sem
w 0 Phone—;aR-;ese, aWlifernia g 495112
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a2 State License �7�63�— Approved
- U j� PLUMBING INSPECTOR
IAiQFIXTURES NUMBER II MARY DRAIN
UNITS I FEES 11 UNITS FEES
Closet
Shower
1,150 11
To Prop. Line
Lavatories
3, DO
To Existing
Kitchen Sink
/.50
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
50
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size It YO
Restaurant Sink
Material JGaA,
Sand Trap
TOTAL FEES
Urinal
Fixture Fee 13 5,0
Area Drain
Main Drain Fee Too
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee 9,6
Relief Valve
Gas Fee p
Vac Breaker
Skimmer
Filter
Permit Fee r7
Total
I?..SDI
Total Fee 7? cn