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No. SIT Lot No. /e'L
o
CATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
0
Sanitary No.
lY -c-> Permit No. S / 0/6,
5-0
3 "(``' 0` . Fee$3r-'r QAItion is hereby made to the City of Cupertino for a permit to install plumbing pipes
w and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
ro U Use of Premises E.Si.L tom.✓C 6
0 Owner T1Z4.P!n o GVJ"- Address
C y
o y By Address /'�? 4:7.0, S.90.-
Z°', Contracto gent .moi..,yyy (7j�R�
o Phone a2f�f3 - 6 3 3 8 O
^a State License —1 60 ,rib Approved
umbing Inspector /
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater a,00 Size
Water Closet Material ?.
Bath Tub To Curb
Shower To Prop. Line
Lavatories Ste' To Existing
Kitchen Sink
Dish Washer
Waste Disposal
Wash Tray cfo SIORM DRAINAGE
Washing Machine /.sem Size 11
Water Softener Material jq
Bar Sink To Main` rain
Comb-Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
I lopper Size I
'
Restaurant Sink Material LV.
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee S"*�
Water Leader Storm Drain Fee
Sprinkler System Water Sys. FeeRelief Valve 11 Gaq Fee /3v
So
Vac Breaker
Skimmer
Filter
Permit Fee
Total / Total Fee