51177.1No. Street Lot No. CQ�
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a ® F P CATION FOR PLUMBING PERMIT
E O ITY OF CUPERTINO
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No.
.ro QV s �!' O Permit No
Y Date 96
° Fee $
3 CITY QF JWPER71NG
hcati is 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
° q in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
Alaws applicable thereto.
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ro m Use of Premises lC�.
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° Owne A>-J'VAFO L v w Z>
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By
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3 ,e, Contractor, Agent
° Phone Z S,S-- 3' 3
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— -i�-State License c�xll�
Address -Z 83� /�EN E TT/
Approved 'm"'^'
Plumbing Inspector
FIXTURES
NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater
Water Closet Al
Material
Bath Tub
Showere
urb
Pron.Line
Lavatories
To Existing
Kitchen Sink
NM C nn.
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
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
_ Sprinkler System
Water Sys. Fee
Relief Valve
11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
__ Total Fee