51240 iii a 7 Y� 7-- , 'd2t.
No. Street Lot No.
o —
d APPLICATION FOR PLUMBING PERMIT
E'
E CITY OF CUPERTINO
0
�G
Sanitary No.
E ate — , 19�_ (T Permit No+s /J- '�e0
Y
Fee $d_Vo
® GC Applicatio eby made to the City of Cupertino for a permit to install plumbing pipes
and/or s listed on the reverse side hereof,and agrees to install said prices and/or fixtures
ine or nce with the provisions of the Plumbing Code of the City of Cupertino,and all other
'c `,IaJes•applicable thereto.
o.
oj�." Use of Premises
m Owner 4-, Address
3 BY � U�-Pi.,/I�. ✓I-(lir/f Address t'��-><3 �>�✓. if/ Y
X Contractor,Agent
Phone '.� S 'S !�� l I� •
3
^ � State License Approved VJILLI.5rI D. D—_NcVICF
It Plumbing Inspector
lWasher
URES NUMBER MAIN DRAIN
Units Fees Units Fees
r Heater Size
r Close[ Material
Tub To Curb
er To Prop. Line
tories To Existing
Kitchen in of Conn.
Washer Dis osal Tra STORM DRAINAGE
in Machine Size
r Softener Material
ink To Main Drain
b.Sink&Tray To Curb
al Unit
Drinking Fountain
nAreaDrain
WATER SYSTEM
Size
Sink Material
TOTAL FEES
Fixture Fee
Main Drain Fee
er Storm Drain Fee
SprinklerSystem Water Sys. Fee
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee a;L—"P6—
Total Total Fee