51064 (2) /o o
No. Street Lot No.
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y /
m APPLICATION FOR PLUMBING PERMIT
G CITY OF CUPERTINO
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risk m�
Sanitary No.
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Y Date Permit N64 / if 6 u
3 Fee Sj 'S
Apglitgti(�n ip�l�ar
and et� the City of Cupertino for a Penni[ to install plumbing pipes
t to iste a hereof,and agrees to install said prices and/or fixtures
° q in accordance with the provisions o e Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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e A Use of Premises.
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° Owner i Wse BeN Address
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w By Address
Contractor,Agent
° PhonS`�S d/02d—
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State License Approved WILLIAM D. BENM- CF
Plumbing Inspector !/
I
URES NUMBER MAIN DRAIN
Units Fees Units Fees
r Heater Size
r Closet Material
Tub To Curb
er To Pro Line
tories To Existing
Kitchen in k • of Conn.
Washer
e Disposal
Tray STORM DRAINAGE
in Machine Size
r Softener Material
Sink To Main Drain
b.Sink&TrayTo Curb
tal Unitking Fountainr Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand TrapTOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stem Drain Fee
Sprinkler System Water Sys.Fee
S�
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee x Z