51182 (2)f-9 Q I / n t i -.l .tr-t -k . toT xn.91�'
NO. 'STREET AL& � 440/
e
APPLICATION FOR PLUMBING PERMIT
z?� CITY OF CUPERTINOzo Sxmtary I�'ui r2 196 Permit Noo aahl_ '�i •� _
1.
Fee $�faa
n 1 I �jhPhcation is hereby made to the City of Cupertino for a permit to install plumbing
o pipes anfl/Lr &W'Y�s li ted on the reverse side hereof, and agrees to install said prices
I and/or fixtures i' d 'HaInce with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto. l
Use of Premises 44 !t{ �� �l•�LLvt'v-�.1't-r A I Aa—Ur A 1 )
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1 N p"
3 Owner/5._J25.b.rx n-C•s'�i 1.Q1 .L1•'•
z J /
, 15 o CONTRACTOR, AGENT
• • a�at►1uaa�
• .i
winn
v g/lState License 9 Approved04 04 1
0
FIXTURES
NUMBER
MAIN DRAIN
UNI'T'S FEES
UN ITS I FFES
Water Heater
/ O
Size
Water Closet
p
Material
AA
Bath Tub
/. 50
To Curb
Shower
/ —p
To Prop. Line
Lavatories
150
To Existing
Kitchen §ink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
1 ,$O
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink &'fray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size I
/a
Restaurant Sink
Material
Sand Trap
roTAL FRFS
Urinal
Fixture Fee
16 .552
Area Drain
Main Brain Fee
$,0C
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
0
Relief Valve
Gas
1,170
Vac Breaker
—Fee
Skimmer
Filter
Permit Fee
IV, 06
Total
// 4,$Q I
Total Fee
, 50