51020 NO. STREE.I'
APPLICATION FOR PLUMBING PERMIT
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z CITY OF CUPERTINO
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Sanitary No.
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipe or Fur=n1.�'f'�{y�f��.{ryryryry�/+111����1 �[Ij}����pt(/��({everse side hereof, and agrees to install said prices
and�it lhttui m .WfJR]R. 1„RV0.1 ae provisions of the Plw bing Code-of the City of
a w Cupertino, and all other laws applicable thereto. ^J
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0 w Use of Premises �k'�-mss �t�eioo ,DSari�
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3 Owner Address
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o CONTRACTOR, AGENT
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- Phone 1�7 .4 / - 3/_4 7.
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a s C 3 G �� b aZ.3oZ WILLIAM D. BE.4EVICH
a A State License Approved
PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pro . Line
Lavatories To Existin
then Sin Not Conn.
Dish Washer
Waste Disposal
Wash Tra STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hoper Size
Restaurant Sink Material
Sand Tra TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve Gq�Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee c
Total Total Fee S�