NO PERMIT NUMBER (2) a�3 LOT NO. �Q
O. STREE.I'
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
x 0 ` Sanitary \0.
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o < Dite + •� 126 Permit No
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A tee $ a31s�
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LL w . Application is hereby made to Tgg��ity of Cupertino for a permit to install plumbing
0 pipes and/ogfixtures listedI`�the Ireveise side hereof, and agrees to Install said prices
and/or 'fiztures in''accoida`nce wrth the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises //
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Own e�T //L�XF/ / /1 Address
z B +�� �/,� /l��t✓ / o Address
J O 1 CONTRACTOR, AGENT
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- m Phone o7�—
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WILLIAM D. 127HENICH
a o State License �-'✓ � Approved
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—0 PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
11
UNITS FEES 11 UNITS FEES
Water Heater 11 Size
Water Closet 1 Material
Bath Tab To Curb
Shower To Prop. Line
Lavatories 1 To Existing
Kitchen ink 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
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TO'T'AL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee 1XI
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee