51016.1 c No. Street Lot No.
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SEP 14 19 1 APPLICATIONCITY OF CUP RTINO PERMIT
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w 1 Sanitary No.
l qp]L Permit No. /O/6./
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3 Fee$--
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
w and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
a Use of Premises 14/'J/!/Oy/L 1
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' m Owner /'7p// i^ 6• A411'LLIJ Address �A�AJ</1/nom -r✓.
.a ti By A/1l�1fI'0� ,X h y Address
3C&ftraft&;Agent7lry'Gts��Y—t4 .
v o Phone 7P - :7fL-
State License A0j—"e 112-4) Approved
.. .01107-14inbing Inspector �_
FIXTURES NUMBER MAIN DRAIN
Units FeesRConn.
Units Fees
Water Heater
Water Closet
Bath Tub
Shower PTOP.
Lavatories Existing
Kitchen in
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 Trap TOTAL FEES
Urinal Fixture Fee A6 Av
Area Drain Main Drain Fee
Water Leader Storm Drain Fee —
Sprinkler System Water Sys. Fee
Relief Valve
Vac Breaker
Skimmer
Filter
Permit Fee d'
Total Total Fee