51015.2 NO. STRF.ra'
APSN FOR I PLUMBING PERMIT
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Sanitary Nu.
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Permit
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oPee $Apn is here ' s i to the City of Cupertino for a permit to install Plumbing
`o a pipes and/or fixes ITsted on the reverse side hereof, and agrees to install said prices
and/or � ,s i71%accordance with the provisions of the Plumbing Code of the City of
a U) Cupertin a all other laws applicable .thereto.
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Use of Premises
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3 Owner. " C)AA S ('e�y'fe Address
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o By J kO• M c elelv,9AA/v V Cm Address a 301 P. m Ave. 5A.
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^I State License D Approved
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PLUMBING INSPECTOR
FIXTURES INUMBER MAIN DRAIN
Units lFces 11 Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pron. Line
Lavatories To Existing
Kitchen Sink 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
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
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Permit Fee
Total Total Fee `1