51028 LOT NO.
NO. STREET
TION FOR .PLUMBING PERMIT
�,s►� CITY OP CUPERTINO
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nA`1U11 91- Sanitary \'u,
° a :IIP � "6 , '1(76 Permit No,
3 U CI�pITINO Pee $ ��
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OOCgpl@Ftir h y made to the City of Cupertino for a permit to install plumbing
`a l�h s 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
a w Cupertino, and all other laws applicable thereto.
LL Use of Premises —1,e 11 117NC je a /
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3 Owner Address[0 -7e(�"
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° CONTRACTOR, AGENT
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a ^ State License —"'Y6 —S' Approved WILLIAM D: BIENEVICF{
PLUMBING INSPECTOR
FIXTURES,.. NUMBER MAIN DRAIN
.Units Fees Units Fees
Water Heater Size
Water Closet, Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen 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 Material
Sand Trap TOTAL FEES
Urinal Fixture Fee 1 7 S
Area Drain Main Drain Fee
Water LeaderStorm Drain Fee
Sprinkler System Water Sys.Fee
/ Gaq Fee, / S?
Vac Breaker
Skimmer
Filter /
Pool Sweeper
Permit Fee
Total Total Fee o