51046 /O 7y 6 I / _� -9—i'�n'e LOT NO.
NO. STREE.I'
W APPLICATION FOR PLUMBING PERMIT
CTY OF CUPERTINO
ro E ' Sanitary Na.
O ' Date EP R 1987 k.,`.196_ Permit No
a
3 U Pee $ 7�
° Al,IjllicS57on�isrher,€b),IiDcs1�1'talthe,City of Cupertino for a permit to install plumbing
o pipes`W/or xtureS'hsted-0n tlV 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
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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3 Owner Address
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z By %0 Address
O CONTRACPOR, AGENT
3 � :r5�6 7 �i�.✓r.� L�Li►s.o
— 0 Phone Ozg6
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0 U State License Approved "'- -•
PLUMBING INSPECTOR U
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 §ink Not Conn.
Dish Washer Sewer Box
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 Fixture Fee
Area Drain Main Drain Fee
Water Leader Stonn Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee ;,7-
Total
ZTotal Total Fee ctl