51001.2 t OAW--10., LOT NO. .�
NO. STREET
D jn ` l4�PJ CATION FOR PLUMBING PERMIT
z G3"e..S CITY OF CUPERTINO
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r Sanitary No.
o Uate `�tt / / 196– Permit No
a
LL Fee $—
To
� Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
LL Use of Premises l !^ -
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o a Owncr��� =�- Address -2:L A- n' i
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zBy Address/° �r�
J O CONTRACTOR,AGENT G%
3 < a9;- ��`
– am Phone
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a o State License
ca'�8�3 r Approved WILLIAM D.D. 9EPI��:tr4l
=U \ PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
U� ITS FEES UNITS FEES
Water Heater Size
Water Closet Materia]
Bath Tub To Curb
Shower 'Co Pro . Line
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
'Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray 'I'o Curb
Dental Unit
Drinking Fountain
Floor Thain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap T I'AL, FEE
Urinal Fixture Fee }
Area Drain Main Drain Fee QQ
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fec
Relief Valve Gas Fee O
Vac Breaker
Skimmer
Filter
Permit Fee
Total / �. J Z' Total Fee