51039 Z2o3S I Cl ee Ksl crP �• LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CUPERTINO
x o Sanitary No.
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0 ' Date I 196.'7 Permit No 3 /O 3
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Application is hereb, made to the City of Cupertino for permit to install plumbing
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`o a pipes afi' y1 tres �i3a pcttfflpeylrse side hereof, and agrees to install said prices
> r and/or fixtures in accorcd}ance wit t tie provisions of the Plumbing Code of the City Of
a w Cupertino, and all other laws applicable thereto.
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a Use of Premises L
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3 Owner CV7 A 4t Address 095�C PCZ`i'J/Li' C�
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CONTRACTOR, AGENT
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- 0 Phone
o State License IJ 3 3 �/ Approved
-U PLUMBING INSPECTOR
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FIXTURES NUMBER 11 MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
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 Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain I WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fees
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee •S�
Relief Valve S'o Gas Fee
Vac Breaker to
Skimmer r0
Filter
Permit Fee �Z
Total Total Fee C^