51118 /OyyD ,C //ULOT NO. �� J
NO. STREE.I'
APPLICATION FOR PLUMBING PERMIT
ITY OF CUPERTINO
ro ® Sanitary No.
o Date ZA - ..9 a 1�6� Permit No e7 6
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, 31 % ,u Fee $ 00
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o Pipes nffa(fiQ es t ¢ verse side hereof, and agrees to install said prices
and/oi�AxtureslN accb4H�n IDIIIIJprovisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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0 �. Use of Premises /`"O d
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3 Owner Address /b�`/y C//1DSi0✓
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, By S//R/K/ST PDDLS Address A� E� C e!Jwl'"
O CONTRACTOR, AGENT
3 a S /36
� Phone
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State License o?0 9 �a b Approve
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater 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&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap 'TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee / S�
Relief Valve Gas Fee S=
Vac Breaker 5�
Skimmer 5�
Filter S
Permit Fee
Total (a i Total Fee ca—