5952 /u v / I 4� LOT NO.
. /
NrSTREET
APPLICATION FOR OLUMBING PERMIT
" < CITY OF CUPERTINO
X
Sanitary No.
¢ 0
0 '
Date I ® erl It
3u
w P 7 rti
° Application is hereby made to the •,r�f Rperarol pe rr} to install plumbing
o pipes and/or fixtures listed on the rea se side hereof, an agr - t`ai install said prices
r a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws app 1 CUPERT�
l" heDV' NO
wx C U
� r
w Use Of Premises
o ° a
oa Owner M a Address 0 C
z� /
z By /�l_-; Address03411/
° COMRA CTOk, AGENT
w
-
< Phone
w z
O s State License Approved
a o
_V PLUMBING INSPECCOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Waterlleater j Size
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 Material
Bar Sink To Main Drain
Comb.Sink R Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYS'T'EM
Hopper Size
Restaurant Sink Material
Sand 'Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve I I Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee cry
Total 'Total Fee ot}