NO PERMIT NUMBER LOT NO.����
NO. ST EET
APPLICATION FOR PLUMBING PERMIT
� ' -` 1 J' �,J -T.I OF CUPERTINO
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! '� Sanitary No.
o Date 2 r19fi �.196Z Permit No
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3 LL Pee$ o�G
' 0 ApplVaE'ibn �s?hereb3'7mgd2ftofthe City of Cupertino for a permit to install plumbing
o a pipes a`nd%or fixtures hsteU ontthe•Yeverse 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
a w Cupertino, and all other laws applicable thereto.
0 o Use of Pre
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3 Owne _ Address
z Address
CONTRACTOR, AG T •"
3 m Phone
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< o State License. ���•>�� Approved
PLUMBING INSPECTOR L,,, 1
FIXTURES NUMBER MAIN DRAIN
_ UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath 'Pub To Curb
Shower / To Prop. Line
Lavatories To Existing
Kitchen Sink / 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 To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYS'PEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stone Drain Fee
Sprinkler Valve Water Sys.Fee 1/1;
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total G Total Fee �7/�