51039 /UT od �N/TK 6/9f �F-i r� LOT NO.
NO. STREFT
APPLICATION FOR PLUMBING PERMIT
z a S�\Z °rITY OF CUPF.RTINO
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a 0� � Sanitary No.
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3 a Date I `> X196— Permit No 3`10
U Fee $ '3/ e
W LL
° e, tfre City of Cupertino for a permit to install plumbing
o W pil5 /o�Qztu{oyj$'c�'�r �atijrcversc 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 Premises
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3 Owner /e-0111!`1 Address //c/' 144 finpaai/�G SZ7
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z B) Address S'/4»r F'-
° CONTRACTOR, AGENT
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- 0 Phone 25-2 /Z
a`o' State License �� "� Approved�� i -
-` , PLUMBING INSPECT v
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater 1 Size
Water Closet 3 Material
Bath Tub I To Curb
Shower Z To Prop. Line
Lavatories 3 1TO E istin
Kitchen SinkNot Conn.
Dish Washer I /S Sewer Box
Waste Disposal I
Wash Tray I STORM DRAINAGE
Washing Machine I Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee o2/ -:'
Area Drain Main Drain Fee S r=
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee 6L
Relief Valve Gas Fee / SD
Vac Breaker
Skimmer
Filter
Permit Fee o2
Total I Total Fee /,c,