51122 (2) LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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a Date 96 rmit No
=LL /ISEp 23 19 8 Fee $ �• Sd
' 0 Application is hereby made to the City of upert no for a permit to install plumbing
`o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> a and/or fixtures in accordancetwithlthe provisions.of_the Plumbing Code of the <aty of
a w Cupertino, and all other laws applicable thereto
Use of Premises
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o < Owner eL Address
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Address- IgG l��ur-u t�r_sst. /LL
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State License a
0 ?-7g0 Approved - -
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U PLUMBING INSPECTOR
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 Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To \'lain Drain
Comb.Sink&'Gay To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixtare Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
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Permit Fee L-l")
Total 11 Total Fee . S U