51000 1 / 4c'lav LOT NO.
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t8P CATION FOR PLUMBING PERMIT
z 0 \`0 CITY OF CUPERTINO
Sanitary No.
0 '��e 119170 Permit No, O
Pee S �3 A
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0 ilication is hereby made to the City of Cupertino for a permit to install plumbing
`o ae 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
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Cupertino, and all other laws applicable thereto.
~ ~ Use of Premises _ _lt l2:V-14 (r n 1 _.24
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3 Owner_G� �r�et t Address 2
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� CONTRACTOR, AGENT
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Phone 2 S 3- 0C+/
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a a26-70
State License,'? �iT Z approved
7.� P UMBING INSPECTOR
FIXTURES NUMBER 11 MAIN DRAIN
Units Fees Units Fees
LK
Water Heater Size
Not
Water Closet Material
Bath Tub To Curb
Shower To Pro . Line
vatorie Exi
Dish Washer
Waste Dis 'sal
Wash Tra STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader rm
Sprinkler System AWater Sys.Fee
Relief V.W,,
Li
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total ITotalFee
0