51135 7-013V Fn k e5-7- ,4 y
p, LOT NO.
WT�i STREET
NOV ,{e3PPLICATION FOR PLUMBING PERMIT
i d N 10 1J11 CITY OF CUPERTINO ,
xo Sanitary No
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0 DaP �� `� — 19�� Permit No
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i „ Pee
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o` a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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�. Use of Premises n
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3 Owner CA n P r�-�'��2. h�)• Address s f n C
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o By.�Cf PL[j(- �U !•- -v-�iAddress,376 fC-'el(Y/'7JAI'T 11
3 0 CONTRACTOR,AGENT
Phone—2 61'7
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Q(,o State License 7 7 c7 Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees 11 Units Fees
Water Heater I ,JZ' Size
Water Closet Material
Bath Tub ToCurb
Shower To Prop. Line
Lavatories To Existin
Kitchen in 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
Ho erSize
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee /,s O
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Ga.%Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee _7 O h
Total Total Fee