51180LOT
NO. Sn EE.t'
/� tgPLIEATION FOR PLUMBING PERMIT
0 Pl ,� r' _ CITY OF CUPERTINO
(` r Sanitary No f,
Date • �Q I'je�% Permit No ...%��.
Fee S_
P�jWYtioO hCr `-Ttl��� City of Cupertino fora permit to install plumbing
pipes and/or fixtures este on tte reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner (—=• �` Z2_
By/4-16W�/I— ��d /i I`V'WA Jt�i
CONTRACTOR, AGENT
Phone.2'-�j
,State License 15-3 TCAL—
,/(/l 1
Address �U 6 O S` "r�`�fVI
Address C
L'[_ c—A; iNU .
Approved
PLUMBING INSPECTOR
V/
FIXTURES
NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prom Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
11 To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
LMam Drain Fee
Water Leader
LStorm Drain Fee
Sprinkler System
11Water Sys. Fee
Relief Valve
11 Gaq Fee. -
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee '��"�
Total
Total Fee '3 6i%