51016.1 (2) LOT NO.
STRE.E.T
N aSEp 14 jqqtPLICATION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
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O P Sanitary No.
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Date e!F I Permit No -> / /G.
Pee $
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 1- 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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a Use of Premises :j)Er G' eG
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, 3 Owner Address P-Si /-.o�J .<"4-
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o B Address/40, 13o . S—�—f
CONT CTOR, AGENT
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coStnte License.��^0�� Approved
U PLUMBING INSPECTOR/
FIXTURES INUMBER 11 MAIN DRAIN
Units Fees 11Units Fees
Water Heater % 11 Size
Water Closet 4v '/ Material
Bath Tub i To Curb
Shower ✓ 'y To ProD. LineJW-
Lavatories te To Existing
Itchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray r / STORM DRAINAGE
Washing Machinew 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 'f— Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve I Gil�Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total V Total Fee