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APP ATION FOR PLUMBING PERMIT
5 �I. 1' OF CUPLRTINO
MAP..
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Sanitary No.
Permit No.. 5f 2 26
o Application t httf�l City of Cupertino
'o pip p"�i2�/o i tit t everse side hereof,
> : and 4'r fixtures In accordance with the provisions of th
a w Cupertino, and all other laws applicable thereto.
w x •
~ Use of Premises
00 z s i
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3 0147� Z/ e-� � AGENT
Phone
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a 2 ,I State License
Fee $ 74% 50
for a permit to install plumbing
and agrees to install said prices
e Plumbing Code of the City of
AddreyGlY��/A��1
Addres PO /f�V�
Approved�/a—X!7
�, PLUMBING INSPECTOR
Flxr"e Cov,,.T ck 31341
FIXTURES NUMBER
MAIN DRAIN
Units I Fees
Units Fees
Water Heater
Size
Water Closet k< rb
I I Material
Bath Tub
Shower
Prov.
Lavatories
Existing
Kitchen ink
Dish Washer
RTNnn
Waste Disposal
Wash TrayAINAGE
Washin Machine
Water Softener
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Sand TrapFEES
Urinal
Area Drain
ZFixtureFee
e /`o
Water Leader
eeSprinkler
System
mv
Rel ef Valve 11
Gas Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
Total Fee