51113 LA n A 2 -2?2
LOT NO.
NO. STREET
q�nMRPPLICATION FOR PLUMBING PERMIT
" < LL�{ QQ n CITY OF CUPERTINO
` ° Juf, F1 197 Sanitary No.
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o a Date 19 L Permit No ..�_/ IJ�U
Fee S .3
o 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
> 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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LL Use of Premises Qei4
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Owner /B k620 S . L , A, Address 54
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a o - State License 2-33 7 Approved00,_
U�. PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fee Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen 'n 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
Restaurant Sink Material
Sand Tra TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Lead, Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve 11 Qa.%Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee 3 .3