51231.1 c No. Street Lot No.
° )W13
C11T OP CJPERTINO
APPLICATION FOR PLUMBING PERMIT
E SCP 2 �9��-----CITY-OF�CUPERTINO------ --- ------
u Sanitary No.
c /�
date 19pl Permit No..S�/.J..j
3 Fee $ �6•,�
.'3 Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
0 in accordance with the provision f the Plumb' g Code of the City of Cupertino,and all other
'c laws applicable thereto.
a o
n � Use of Premise
o �
° Owner Addres
c m
By Address
3 r onlrac Ag
° Phone
s= ;en
aWI!.LIAM D. HENEVICH
State License` Approved
Plumbing Inspector
i
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater ) Size
Water Closet Material
Bath Tub I To Curb
Shower To Prop. Line ✓
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
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 3
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee (�
Area Drain Main Drain Fee cU
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee J 5-0
Refief Valve Ga�Fee
( s0
Vac Breaker
Skimmer
Filter
Permit Fee ?•O.O
Total Total Fee