51016.1 7-7
No. Street Lot No. '3
o —
ani APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
0
V Sanitary No.
0
ro o Permit No. . -/O/G,/
E Dat
0 Fee S�u
3 I�'
App trod 4bLhc �' ��to ty of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reve a hereof,and agrees to install said prices and/or fixtures
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
o lavls��ii' caUrtherCRTINO
� = f
A A Usee oof Premisess
.ESic�,ENC�
o_ U
' ° Owner Address 7y /,Ax 0
nn
= � BY /��,y• �ia.!<cy P/.68 . Address Ao.
3 z � Contra or,Agent
Phone
7-19.'jp
State License —761O S� pproved -
mbing Inspector , /
FIXTURESW/ N�.t
MAIN DRAIN
Units Fees
Water Heater y' c,
Water Closetrial C.TBath TuburbShower 'm . LineLavatoriesxistinKit he inknn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine ,T-11 Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size /• j
Restaurant Sink Material 6 a J'0
Sand Trap TOTAL FEES
Urinal Fixture Fee "',500
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Pee 3
Relief Valve 11 GAq Pee
a o
Vac Breaker
Skimmer
Filter
Permit Fee b0
Total /d— / Total Fee e2