511891066- 668- M Rum
No. Street
1)"Jeolkut
O AP TION FOR PLUMBING PERMIT
V , 3 i1JJ7O CITY OF CUSanitary
Sanitary No.
v�� 1 09-40 Permit No. 51I R1
v Fee S
Lot No. zq_
F t: N its
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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
Owner Q1/ Ems`/ "N YT Co .
By SM,1 JoSk- MFz"A-01 C AK, 11JG
Contractor, Agent
Phone 'J --i ) - n O � 4
State License Z64 zAS
Address
AddresA66 e.EQ.S AUE, :SJ
App'!"70
Approved
x lumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units I Fees
Units
Fees
Water Heater
Size
Water Closet
l
Material C
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
I
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
r
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size 1
1 Soo,
Restaurant Sink
Material 1
Sand Trap
TOTAL EES
Urinal
Fixture Fee
pO
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
1 S�
Relqef Valve,
Gas Feey
00,
Vac Breaker
Skimmer
Filter
Permit Fee
Total
i}$
Total Fee IR
-V So