51073 22363 I LOT NO. �� I
NO. STRP.P.a'
CITY OF CUPERTINO
Z < carr ATEft ��•�cuvEftTir+oAPPLICATION
Z \7ATFOR PLUMBING PERMIT
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o �jrei 26 �`� 19 — Permit No S/ O 73
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0 A`pp Iltcation is hereby made to the City of Cupertino Cor a permit to install Plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
J LL Use of Premises -RE S i O6NL.L-�
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o a Owner h C. P4 E'C'S Address
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CONTRACTOR, AGENT
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a o -State,License C�G2 Approved
PLUMBING INSPECTOR ��
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size `+
Water Closet Material G
Bath Tub i' To Curb
Shower I To Prop. Line
Lavatories To Existirm
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Wash w
ing 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 ° I
Restaurant Sink Material
Sand TrapTOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relqcf Vnlye 11 Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee o2
Total jj Total Fee o2