51016.1 No. Street Lot No. /6
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APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
E
Sanitary No.
E Dat Permit Nos �d/G•/
3 Fee S31 d�
A n ereb made to the City of Cupertino for a permit to install plumbing pipes
a t lis de hereof,and agrees to install said prices and/or fixtures
O in accordance with'Eh�prbV , JI16Lthe Plumbing Code of the City of Cupertino,and all other
A
c'c laws applicable thereto.
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m
A � Use of Premises
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' ° Owner C�s✓��c�...i d T Address
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o �n By �1'Jg 115�56 Address/L� 30� vT�y
Contractor,Age'
N ° Phone —sYB —6 37 g
State License �6 O .:S—"i 6 Approved
24*mg Inspector
FIXTURES INUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet ,�" 3' Material C.,�:
Bath Tub / To Curb
Shower / To Prom Line
Lavatories To Existing
Kitchen Sink /S ' I Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink .Sfl To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size /"
Restaurant Sink Material �',r�✓.
Sand Trap TOTAL FEES
Urinal Fixture Fee of/el
Area Drain Main Drain Fee
Water Leader St rm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve
6
Vac Breaker
Skimmer
Filter
Permit Fee o'C 0.0
Total / Total Fee
3/.0-0