51075.11 Plumbing /! o I � YE' LOT NO.
NO. SnEP.T
f APpLICq�ON FOR PLUMBING PERMIT
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x o Sanitary No.
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o a Date Permit No
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' 0 A I �¢q�is b•/tp�Oj jty of Cupertino fora permit to install plumbing
`o a Pipes ar>�yAkyixtOFs IiU�d�OC�� RUse side hereof, and arees to install sid proc
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and/or fixtures in accordance with the p
rovisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto. -
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a Use of Premises
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0 3 Owner / /N UkTf - /�CCESj �slGfs (.tui Address ✓�'voECiOlF l�v�
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'CONTRACTOR, AGENT
3 m Phone �y�� 7 97rf � •f
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Q o State License 17`72 �� Approved �II I IOM D. BENEVICH
U �' PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material _
Bath Tub To Curb
Shower To Pron. Line
Lavatories To Existin
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Matervi,
Bar Sink Taaln Ur
Comb.Sink&Tray I To Curb
Dental Unit
Drinking Fountain
Floor Drain ATER SYSTEM
Ho er ' Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee '
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve r7p�,
Vac Breaker O
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee