51234 (5) T n 1
10159 So Blaney LOT NO. T'—r. 98
NO, STREEI'
CRY OF CUPERTINO CITY OF CUPERTINO
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JUN 8 �9-APPLICATION FOR PLUMBING PERMIT
x o Sanitary No.
0 :i 1A A I D May 24 ig Z Permit No J/ 1 3
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W LL tee S-2-Z
1- 0
1- Applicatwn 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
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 Laundry Room
00
oa Owner Jnrnme WhLhe Address 10159 So_ Blaney
San Jose Mechanical.,hanical„ Inc, Address 1665 Rogers Ave. S,J,
O CONTRACTOR, AGENT '
3 275=9044
— 0 Phone
w = 6- 1V
a oa 264285 Approved 1ML
State License /
\L. PLUMBING INSPECTOR I
FIXTURES NUMBER MAIN DRAIN
Units I Fees I Units FFees
Water Heater /.SD Size y° 5.00
Water Closet Material C i
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existine
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 4jy?..00 Size
Water Softener Material
Bar Sink I To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain /,5-0 WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain LMam Drain Fee X.00
Water Leader -11Storm Drain Fee —
Sprinkler SystemWater Sys.Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total /100 Total Fee 1 t.0O