NO PERMIT NUMBER /O/ /(7 I ¢h.T/C.ff LOT NO.
NO. STRF.F.I'
APPLICATION FOR PLUMBING PERMIT
W d CITY OF C TINO
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Permit
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on dw-mvernedeftipf and agrees to install said prices
i w and/or fixtures in accordance with the provalou hRT Ong Code of the City of
a W Cupertino, and all other laws
flaws applicable thereto. v
,. Use of Premises t'7 S•
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oz OwneB�Z Lim Address�"1 �S�4S , /tLl/4!/ALE
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O CONTRACTOR, AGENT 725 l;Tlarles �r�
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0 Phon,S/g aSSb San Jose, California 95112
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t' a o State License 7�S �:2 Approved
t —U \ PLUMBING INSPECTOR �/
l'FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater SO Size
Water Closet Material C•
Bath Tub To Curb
Shower 340 To Prop. Line
Lavatories To Existing
Kitchen §ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
W sh Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main
Comb.Sink&Tray T r
Dental Unit
Drin king Fountain
Floor Drain WATER SYSTEM
Hopper Size " $D
Restaurant Sink Material fir/
Sand Trap 'TOTAL FEES
Urinal Fixture Fee /
Area Drain Main Drain Fee
Water Leader Stone Drain Fee
Sprinkler Valve Water Sys.Fee rn
Relief Valve Gas Fee fie.
Vac Breaker
Skimmer
Filter
Permit Fee 00
Total tal Fee Se')