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NO. STR F.l'
APPLICATION FOR PLUMBING PERMIT
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3¢ 4 /00 ai9
� 19�� Permit No
Pee $
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� �]ti a y to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixture vith the provisions of the Plumbing Code of the City of
a w !'rL rt i�Fan � t'IrlJapplicable thereto.
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J Use of Premises _0
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oa Owner�eRA f>tZZAk l A Address
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J CONTRACTOR, AGENT I/ �-
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an WILLIAM D. B^N�/ICH
< £o to License 2- l a 4 n Approved
U PLUMBING INSPECTOR
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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 k Not Conn
Dish Washer
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
ve
Sand Tra TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valy�. I Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
—
Total Total Fee a'�