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E LOT NO. �7 /
NO. STREET
APPLICATION FOR PLUMBING PERMIT
ITY OF CUPERTINO
Sanitary N n.6Z.
llate +� ��196� Permit No ���9 7
1 S�
Fee $ Z
pjcatiq�is hereb - made to the City of Cupertino for a permit to install plumbing
p 9 rjd/c�Ur �xt jj�%t, reverse side hereof, and agrees to install said prices
and/or fixtures m actor ,�d�}ttft) the provisions of the Plumbing Code of the City of
Cupertino, and atl othernlaws applicable thereto.
Use of Premises ReSic/eNGC'
Owner CT'e'Y' 4 A 1416 0 x d
CONTRACTOR,AGENT
Phone �,y/
State License /' dNel 0WNC/
Address .21622
Ce/w�L4f /dre
Approved Irl"
/
PLUMBING INSPECTOR V
Permit Fee 1.00
Total Total Fee •SO
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
I UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
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 SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
,'� .60
Water Sys. Fee
Relief Valve
11
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 1.00
Total Total Fee •SO