51139 (2) 305-70 Su✓RilE DR.
c No. Street Lot No.
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aci APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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U � Sanitary No.
xp - b 1 _ Permit No.
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Application is hereby made ity of Cupertino for a permit to install plumbing pipes
o ancj(Qrrf�jCtu(q�ist 40e hereof,and
d agrees to install said prices and/or fixtures
m an dh rovrsIons of the PlumbingCode of the Cit of Cupertino,and all other
c'c laws applicable thereto.
'/ �7 Use of Premises Jnr 04d HJ 6/C,-
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d Owner OKl� G 1�)OUJ�MCq l Address l 7J fV Ne�ffi
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c vi BY v�Er!� Address
3 Contractor,Agent
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— ^c State License Approved a
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Plumbing Inspector (/
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet /. Material
Bath Tub To Curb
Shower 15V To Pro . Line
Lavatories 1.0 To Existing
Kitchen in Not(-onn.
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 , SO
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Re]6ef Valve Gaq Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee