51231.1 t007-4 mo-ssvLOT NO.
STREET I IA I3 ` 1'
CITY OF CUPER LINO
z 2 SEP 4AI)RICATION FOR PLUMBING PERMIT
r 0 Sanitary No
0 [)are 19 U Permit No S/ /
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w LL Fee S
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� 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
r I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
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Use of Premises RF S t {�J1 C E-
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3 Owner1�k0. P Address 59, V
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o By ( ll (.� IP i � ,1 Address VP�L�. UJE J
CONTR CTOR, AGENT
Phone � — �� 4:()
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i /; WILLIAM D. 6ENEVICH
� State Licen.e �`� �) Approved
- J PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size zp
Water Closet Material -
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.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink I Material 1
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee , •j
Relief Valyc 11 Gas Fee A be)
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .Q
Total Total Fee 0746