51086 (2) LOT NO.
NO. STR .F.l'
�A,Sp PLICATION FOR PLUMBING PERMIT
xo � /^_\\ - TY OF CUPERTINO
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3 a Uat•- I IG 1 196— Permit No �S%o
i4 Fee $
0 ca is� q �-{ I the City of Cupertino for a permit to install plumbing
`o r p{�ies! and��fixrlfjp sJ£[lldnnvtk l 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
a w Cupertino, and all other laws pI cable thereto.
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LL Use of Premises --a---N
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0 3 Owner L 3-b%A Address
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O CONTRACT AGENT
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n 2 d �rILLIAM D. RticlICH
1 a s State License ` 17 1 Approve
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—0 PLUMBING INSPECTOR
FIXTURES NUMBER jj MAIN DRAIN
UNITS FEES UNITS FEES
Water Healer Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer 11 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
Drinking 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 Water Sys.Fee
Relief Valve Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Ljotal Fee