51231.1 c 2 I Ana , PsLtC- C2(, I< W�, m,No. ;z- C>
CITY OF CUPERTINO
Z
cm of cusp&ICATION FOR PLUMBING PERMIT
x 0 SEP ,1
aSanitary No.
o < Date- 9 12 19 Permit No,�_1
3
2 u AFee $ ;3.56
LL
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
> I 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.
LL Use of Premises �.e�,lC1E�� C C
00 //
oa Owner_ I Address C)am Lr Q 10—z J
z By C C- Address IM )IPtJ
3 CONTR CTOR, AGENT
— Phone 2 ' ¢Z Q
W
f State License I 4 Approved l".'iLLlf.7 D. BENyVICH�
a o /
V' PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fecs
Water Heater Size
Water Closet Material C.
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.S ink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material u
Sand Trap TOTAL FEES
Urinal Fixture Fee �J-S O
Area Drain Main Drain Fee J
Water Leader St m Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve I Gag FCe
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .OJ
Total Total Fee 3. S