51002/03
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No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Lot No.
Date o - 9 - G?1;CT
�1 �1 r�p Permit No? / 0 2
14 1900 Fee S 3'a
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reryerso.de Weof,ag{ -es to'in tall said prices and/or fixtures
in accordance with the provisions oi O' of Cupertino, and all other
laws applicable thereto. f the P.lumbi S
Use of Premises
n„�, 1p
Owner W4 ,p
Contractor, Agent
Phone
State License)% % �d
Address
Address /OJ"'Y'��'Z.y S.7
Approved
Plumbing Inspector
J
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
3
Size 'I '
Water Closet
Material GY
Bath Tub
J
To Curb
Shower
.3
To Prop. Line
Lavatories
To Existing
Kitchen Sink
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
YSTEM
Hopper
�/Restaurant
Sink
.,f 4Sand
Tra
Ar FEES
Urinal
NFixtureFee
ee G.
S -Z
Area Drain
n FeeWater
Leader
in FeeSprinkler
System
. Fee
4-0
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
• W
Total
iL3
Total Fee .i