51069 /6/Y,/, A'IJPL
a No. Street y - Lot No.
wAP ION FOR PLUMBING PERMIT
E ^ CITY OF CUPERTINO
° I
Sanitary No.
�i K i 1 Permit No. -51069
J. G� vl-
a Fee$ -7-
A
n a
Application made to the City of Cupertino for a permit to install plumbing pipes
and/or listed on the reverse ide hereof,and agrees to install said prices and/or fixtures
Sd in acro with the provisions of the Plumbing Code of the City of Cupertino,and all other
F laws applicable thereto.
'41
Use of Premises
-
7.
Owner Address
02
F m
h a B° y/3 .,,- n�.n Addressa�
3 rr. Contract r,Agent f /
u `o phone
is s-7/
State License 2 Y RY 9. Approv
lumbing Inspector
FIXTURES NUMBER . MAIN DRAIN
Units I Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pro :Line
Lavatories To Existing
Kitchen Sink 1.50 Not Conn.
Dish Washer "
Waste Disposal .5GJ
Wash Tray STORM DRAINAGE
Washing Machine Size -
Water Softener Material
Bar Sink
r
ain Drain
Comb.Sink&Tray urbDental Unit
Drinking Fountain
Floor Drain ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand TrapTOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys, Fee
Vac Breaker
Skimmer
Filter
Permit Fee 2, 00
Total Total Fee S.Do