NO PERMIT NUMBER /0!33 I i E 06 LOT NO.
N0. STREET,,
i f" APPLICATION FOR PLUMBING PERMIT
z a // CITY OF CUPERTINO
o �wG 1 .2 1`8 Sanitary No.
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° < Date to 196SZ Permit No
FeeSo? S. D �
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° Application is hereby made to the City of Cupertino for a permit to install plumbing
opipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> a 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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Use of Premises E
° °
3 Owner . Address
By e-VdW! 'tgsCD•, 1A
O CONTRACT/OR, AGENT 625 Charles Street
3 < .56 Phone SSan lose, California 95112
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p a 17153 Approved WILLIAM D. SEN7..•C
ff 11 a o State License /
u-U 7C PLUMBING INSPECTOR'. /
CC / \ III/// ,
FIXTURES NU116ER G MAIN DRAIN
UNITS Ir JIl UNITS FEES
Water Heater / Size (1 .oV
Water Closet Material C
Bath Tub /• To Curb
Shower /,•3�a To Prop. Line
Lavatories LL.f-7 To Existin
Kitchen Sink / /..rV Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine / J 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 q L .iv
Sand Trap TOTAL FEES
Urinal Fixture Fee f "
Area Drain Main Drain Fee ,r_6U
Water Leader I Storm Drain Fee
Sprinkler Valve Water Sys.Fee / . ,TO
Relief Valve Gas Fee /it17J
Vac Breaker _
Skimmer
Filter
Permit Fee t
Total /D /(" Total Fee d x' d tJ