51192 (2)1190 7 i.../ LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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E Sanitary No.
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3 date 1 3 19611a
Permit No -5—lei L
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o apipes 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.
LLUse of Premises �E 5
00 �1
� 3 OwnAddress
Address
o JL'wMa! SeWice Co., Sim
z By Address
3 , kNSIT.eAENT
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Phone San Jose, California 95112
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VVILLIA-M D. 13E:NEVICH
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a o State License iZZ,6U7 Approved /
�— U ,x PLUMBING INSPECTOR ✓
FIXTURES
NUMBER
MAIN DRAIN
j
UNITS FEES
UNITS FEES
Water Heater
O
Size
Water Closet
3 . P
Material
Bath Tub
SO
To Curb
Shower
1. <77
To Prom Line
Lavatories
SO
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
s
Size
Water Softener
Material I /
Comb.Sink & Tray I 1 11 To Cure
Drinking Pountaln
Floor Drain WATER SYSTEM
Hopper Size�'� O
Restaurant Sink Material —o- u
Urinal
ix Ure ree
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve I
Water Svs. Fee I �d
Skimmer
Filter
Permit Fee p
Total /d /5500 Total Fee °f