8017 1�_�4 � LOT NO.
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601 PUIG T N FOR PLUMBING PERMIT
AR 13 1 68 .}TY OF CUPERTINO
' 0 Sanitary No.
2 LL
o 196f/� Permit No O/
L RTINO Fee-$ ''a3
2 LL
' 0 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 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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, LL Use of Pre ises _�S/OFn/T/i0< ��.I/AA..A /.✓6 onL
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3 Owner Addresem/21, Zew/'—
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YCOI4TRACTOR, AGENT
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u s State License r✓ee��g :2 9 Approved
�{-V PLUMBING INSPECTOR/�/
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FIX'T'URES NUMBER MAIN DRAIN
UNITS REFS UNITS FEES
Water Ileater Si ze
Water Closet Material
Bath Tub To Curb
Shower To Pro . Line
Lavatories To Existin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray TORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drin king Fountain
-Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee 46a
Vac Breaker
Skimmer
Filter
Permit Fee I �1. OD
Total Total Fee 3,