51192.2LOT NO.
O. EET
P�A LICATION FOR PLUMBING PERMIT
r\0�1 CITY OF CUPERTINO
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Sanitary i\'o.
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3 Permit No. IS—//"? -2.
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p11t'ation is hereby made to the City of Cupertino for a permit to install plumbing
I and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
AGENT
Addresses/L
Address-V'41
State License �P �Z— Approve .L - -
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IMIrI u. Li Z1UZ VI
PLUMBING INSPECTOR
FIXTURES NUMBER I MAIN DRAIN
UNITS I FEES UNITS I FEES
Lavatories To Existin
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Size
Comb.Sink B Tray I 1 11 To Curb
Area Drain
Filter
WATER SYST
Si ze
Material
TOTAL
Storm Drain Fee
Water Svs. Fee
Permit Fee
Total Fee