51120 1d6 3 )�'. gtl-c Le)A"r D?. sJ
No. Street Lot No. d 1
°
° RP LICATION FOR PLUMBING PERMIT _
CITY OF CUPERTINO
E 1
O � ySanitary No.
lIh\ t Permit No.
o J
3 \ `� Fee $ �G.>7U
Ap cation is hereby�im�ade to the City of Cupertino for a permit to install plumbing pipes
and/or fixtureallisted on the reverse side hereof,and agrees to install said prices and/or fixtures
oN acco5dabce'wi'th the provisions of the Plumbing Code of the City of Cupertino,and all other
= 11c laws ePPhcable theretoq
h A Use of Premises
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° Owner —e�-.�.// Address
d �
G N BY f-,�CiLjfL1� / KL(ii�.X'..(.in Address
3 r
Contractor,Agent
Agent -
. ° Phone
— State License d-I;Ary 9 7 �" 3- Approved �—I /
�/Plumbing Inspector V
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Sa Gi / / o Size
Water Closet Material
Bath Tub / ,40 To Curb
Shower / .f0 To Prop. Line
Lavatories � To Existing
Itchen in / .S'O Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener J1 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 / •D
Area Drain Main Drain Fee .S=
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee $2t
Relief Valve 11 Ga.%Fee
Vac Breaker •} o
Skimmer
Filter
Permit Fee 0-V
Total $a Total Fee