51118 MT?l C ESTI rrS' D2
LOT NO.
NO. STP EF.I'
APPLICATION FOR PLUMBING PERMIT
z a CITY OF CUPERTINO
s XCIV 0? CUI`E;;tINO _
x O Sanitary No.
3uS� It`� 1917 9' 2� 19 1 Permit No w
w Pee S
10
LL w P A�li�ti - is hereby made to the City of Cupertino for a permit to install plumbing
0 , pipets 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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0 3 Owner Address s^r'
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.� z By �C Q` I L /jC J-C'IG I c6 4�Lv o-4`- Address .�7��[/'�7vn i✓�r '1 S�T
O CONTRACTOR, AGENT
3N Phone
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a o , State License 2 3 7 ' 0 Approved
U PLUMBING INSPECTOR
FIXTURES NMBER MAIN DRAIN
,. U U'ts Fees Units Fees
'I;. Water Closet
)v Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
Lavatories 11 To Existine
Kitchen ink Not Conn.
Dish Washer
Waste Disposal
_ Wash Tray STORM DRAINAGE
Washin Machine 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'Trip TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Lea erStorm Drain Fee
Sprinkler System Water Sys.Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
r
Permit Fee ;2- o O
Total Total Fee .3, a