51120 /07a'/ I�/q/1/3'%/�/nL 12/Z LOT NO.
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
< CITY OF CUPERTINO
z z
w
x o Sanir.Iry No.
Q LL
H f D d 19670 Permit No r - 11,20
3 LL , N O 9n Fees 3
Application is hereby made to the City of Cupertino for a permit to install plumbing
`o p}�f�- ld,�q fish�'nL�rQ� 44N�((��e reverse side hereof, and agrees to install said prices
> a � fiskA�es Ik4Rh L"s!-TYfI the provisions of the Plumbing Code of the C-ity of
a Cupertino, and all other laws applicable thereto.
w x
Use of Premises
J LL —_
� n
7 N
. 3 Owner ms" . Address /D'7,16/ F�.a/tV dUz o )
o a
zJ
z By)aC E /��un, d/na �t2 Address 396 )9R1Zavh,�k7-
CONTRACTOR°AGENT
3
- Phone _� 9 7- Vz 0 7
w z
a o •tate License !J-3 7 9 0 Approved_
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
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 `
Sand Trap TOTAL FEES
Urinal Fixture Fee k
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief VAlye Gag Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
A46 i
L
Permit Fee
Total Total Fee S