51070 (2) A;'
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No. Stree /N !/e Lot No.
O
d APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO e'.�JTI N
ySanitary No.
.G
Y , 196 7o Permit No. rI d 7O
0 I (��P tt ppI(� Fee$7 X 00
App kation is hereb t��d`tDCity of Cupertino for a permit to install plumbing pipes
and/or tixtyte�e lis( ••p''`Ih�`reverse side hereof,and agrees to install said prices and/or fixtures
° A inaFcp dan a with a provisions of the Plumbing Code of the City of Cupertino,and all other
la sappllicable thereto.
A v Use of PremisesZ /�'IT /NKl �Nsrrnurn� �S PER 695y.P.e,
0 /�
° Owner L�BThwe-, LUTli2,4/ Address
9
o yr By �H�CN Address
3 s Contractor,Agent
° Phone �
a m -7�
-� State License Approved '
1� C�p4f 274.3 VPlumbingInspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material CV
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen ink Not Conn
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.S ink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size C
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee 510
Relief Vmlye Caq Fee
Vac Breaker
Skimmer
Filter
Permit Fee .0 O
Total Total Fee