51113 /De7�O I ( 'd'l LOT NO.
NO. F.T
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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x o Sanitary No.
0 < Date Permit No
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' 0 Applon is hcrrre1y IQ�A to th w ity 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
> ` and o� es�--ac '� c �� provisions of the PlumbingCode of the Cit of
<w Cuper6ii���n S& o t!i ' e thereto. y
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Use of Premises
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3 Owne ./i1 Address D330
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r CONTRACTOR, AGENT �-cL
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ao State License. Approved
0 PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS1 FEES 11 UNITS FEES
Water Heater I Isize
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 0 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 .6-0
Area Drain .Main Drain Fee
Water Leader Stom Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total 01 Total Fee j