100220 / IfOC- ldllt� l^ � 12 d'L Y /J74- LOT NO.
NO. STI EEI'
,jPATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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o ' [)ate 196— Permit No /� d .2.0
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U Fee $
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Appltefifion y�//����y�7 mde to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixT[hc cftVn the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordSncLlOwith the provisions of the Plumbing Code of the City of
a Cupertino, and all other laws applicable thereto.
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0 LL Use of Premises ,//l""'� „'_✓/
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r3 Owner Address
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O CONTRACTOR, AGENT
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u WILLIAM D. GEN=VIC
c s State License ��'^'"" Approved H
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 Sink 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 LFixturc Fee
Area Drain LMam Drain Fee
Water Leader LStom Drain Fee
Sprinkler System 11Water Sys. Fee
Relief Valve 11 Gaq Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee