NO PERMIT NUMBER LOT NO.
NO. STRF.EI'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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x o ® _ Sanitary No.
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o D 7 p C7 1962 Permit No
OV W ,U , .L Y 1901 ' Fee $ .-,� —0
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
" r d fi e reverse side hereof, and agrees to install said rices
a a i* fiWres 9nl�(ccbc(1'tz i i h the provisions of the Plumbing Code of the City of
Q w Cupertino, and all other laws applicable thereto.
w ~ Use of Premises
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3 Owner ^yv Address��/ �
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O CONTRACTOR. AGENT
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— z Phone
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y�/ILLIAM D. GENEVICH
a o State License �?.�fl�`r``� Approved"
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`}_ PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Rester Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories T. Existin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener ,.TO 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 TO'T'AL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
S rinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total a Total Fee