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/4i NO. c. I / i✓L�iL_OM./ C+ LOT NO.
NO. SIRE F.T
APPLICATION FOR PLUMBING PERMIT
�- CITY OF CUPERTINO
ftotfAp�
/Sanitary No.
Date t 1 66E Permit No
9 969 LU" Pee$
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or �fi1xture lij dS_��° ,,tPel rwerse side hereof, and agrees to install said prices
and/6r1r1>''iu[e91n a �LF�wljhj to provisions of the Plumbing Code of the City of
Cupe`r4no,ranYill other Ipvs applicable thereto.
Use of Premises
State License ��G 5-7l
VdiLLIANI D. ScNBVICH
PLUMBING INSPECTOR
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Own
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CON TRACTOR, AGENT
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State License ��G 5-7l
VdiLLIANI D. ScNBVICH
PLUMBING INSPECTOR
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FIXTURES
NUMBER
11 MAIN DRAIN
-
UNITS1 FEES
11 UNITS FEES
Water Heater
/
Size
Water Closet
Material f,
Bath Tub
To Curb
Shower
To Prop. Line •�
Lavatories
To Existing
Kitchen §ink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
J
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee lelsol
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee