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t7 APPLICATION FOR PLUMBING PERMIT
V0 CITY OF CUPERTINO
E
r Sanitary No. '�—
P �f5/0/5.2
Y Date Permit No.
3 Fee S 4 d
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
`o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'c laws applicable they to. N
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:e u Use o(Premises T&E
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oOwner l P)oaC) jC& A, U ILS��( Address
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e rn By 7)g- (j14m t` `4 L13, _ Address o(�9 2 Cc,lTl1� /y1L c'
3 Contractor,Agent �}
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State License 96Ct. Approved v
tumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I L.X Size 4 1.4 4
Water Closet 7— 7.60 Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not
Dish Washer nN /•Si7
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink I To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Sizeu
Restaurant Sink Material Tbl •r�'O
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valye 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee .D