2696 iaaG/ PhAP C 9s' /J2. LOT NO. 'S</
NO. Qr
AON FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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R APR 17 1064
Y O ate Sanitary !AU.
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o � Dy/��2/�C- /O �I96 Permit No
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W LL CITY OF CUPERTi�.'t Fee
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o a 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 ES/.OE/I/C
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3 �l/O— Address 1ya8/U cU/A/Ci/ES7-6e .S'J.
o a Owner /
/y» d/ iG AddressP /4
O CONTRACT R,AUEN7
3 v`, Phone X96-393 /
f State License ��'�2- -Approved
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--TET MRNUMBERMAIN DRAIN
UNITS FEES UNITS FEES
Wdter Heater / Size [ W
Water Closets Material 61,54
Bath Tubs / OD To Curb
Showers / To Prop. Line
Lavatories �6w To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines / Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
De4al Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaivcs Water Sys. Fee
Permit Fee �,Q
TOTAL TOTAL FEE Oy
RECORD OF INSPECTI
Underground
.Partial Rough.-
Rough. Complete..
\Iain Drain