51027.7 (3) No. Street Lot No.
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01 P.191� APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
U Sanitary No.
7 �C� 7 7
E Date� -��}— 19p�Permit No.S
3 Fee S (f–(;fv
s 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
° in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
.E laws applicable thereto.
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„ Use of Premises
o ° Owner C/6� v .,rv�.-, Address
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Address :d v G 9nc
3 Contractor,AgentN/
X ° Phone
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Stale License r}CJ S 7 </.� Approve
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 0 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 o d
Area Drain Main Drain Fee
Water Leader
Sprinkler System Water Sys.Fee
Ga�Fee
Vac Breaker
Skimmer
Filter
Permit Fee 0
Total Total Fee C5 C'n