51231.1 LOT NO.
N0. STREF L V I R
C1►Y Of CJfc[Tt11p CITY OF CUPERTINO
" < SEP 17 1q�PPLICATION FOR PLUMBING PERMIT
w �
x o 5mnitary No.
•o � Date A { 19 L( Permit No. Z_?/ /
W LL
Fee
S O
� Application is hereby made to the Cit}' 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
> . and/or fixtures in accordance with the provisions of the Plumbing Code of the ('try of
a w Cupertino, and all other laws (applicable thereto.
.. Use of Premises 1L.t°.S LQ' 2AC e
00 ( J
oJ r Owne _ Address �pp//__,tA' ,r, 1(A,r G--
Address V06A' idle)
J CONTR CTOR, AGENT
3 m Phone
w z G
a o State License 1��J Approved WILLIAM D. B=NEVICH
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size '
Water Closet - Material
Bath Tub I To Curb
Shower ITo Proo. Line
Lavatories z To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washin 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 3
Restaurant Sink Material
Sand Tra' TOTAL FEES
Urinal Fixture Fee 3. -yo
Area Drain Main Drain Fee 00
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Re]ef Valve Gas Fee S0
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee J
Total Total Fee 3.5-0