51189� o 1 5l+ r -i aRy
No. Street Lot No. 2,
famNOV `{ - Fvart1
ft
�A P ATION FOR PLUMBING PERMITCITY OF CUPERTINO
n&319 10 Sanitary No.
CII)ate 3 I9z 0 Permit No. �I18
I r -OF L;UPtt(l Q Fee S 9 ySo
Application is hereby made to the City of Cupertino for a permit to install plumbing 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 Cupertino, and all other
laws applicable thereto.
Use of Premises Aq-T S.
Owner AV ;�-Q,/ r n ,.1ST. Ca Address
By SFNJ Je.sr 1-t Ec-k&,11e-tvt. I Qr,
Contractor, Agent
Phone S- Q0µ4kl
State License X2-6 PIKS
Address IbLS� 12n6E95 AV£ 5J•
//Appov�d �
`` lumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units I Fees
Units
I Fees
Water Heater
Size
Water Closet
i i
Material L
Bath Tub
$
To Curb
Shower
8
To Prop. Line
Lavatories
l2
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.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
2 -
Area
Area Drain
Main Drain Fee
$ °o
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
1
11
Gas Fee
Y J,
flSkimmer
Permit Feelv4tl
Total Fee
s�