51192 (2)/9W 1r6s,�r LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
X CITY OF CUPERTINO
Sanitary Nu.
R
3E` Drf R _ 3/ 196 Permit No.�—
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install saidrices
> 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 — FS
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3 Owner_�'t`/q_H k6tg:5 c--A,ddress
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3 By CONTRACTOR, AGENT Ch Stfie�
— < Phone A/ �'OS"5L San lase, California 95112
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Approved0 State License i7
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C - C) ' \ PLUMBING INSPECTOR (/
FIXTURES I NUMBER MAIN DRAIN
P, Vr I UNITS I FEES UNITS I FEES
Material
Shower
To Proo. Line
Lavatories
4o•06
To Existing
Kitchen Sink
�,�
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
WATER SYSTEM
Hopper
Size
//
/-
Restaurant Sink
Material JS44U
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee .�
Sprinkler Valve
Water SYS, Fee
j jJ
Relief Valve
Gas Fee ,
fp
Vac Breaker
Skimmer
Filter
Permit Fee
19 D
Total /
:i0
Total Fee
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