51027.7 (2) LOT NO.
NO. STREET
PAPPL-ICATION FOR PLUMBING PERMIT
aJv 1 ITY OF CUPERTINO
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r o I I'/ Sanitary No.
0 a Date P 1 g 1196 C C� Permit No $ boa 7•
w LL Fee $ ` . SO
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' 0 APplir><tionr¢ harrelj7Tita�fo't11City of Cupertino for a permit to install plumbing
o 1 pipes and/or fixtures listeclon-the- reverse side hereof, and agrees to install said rices
> < and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws appliyable thereto.
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n Use of Premises
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o3 Owner,(� /J Address p
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i- CONTRACTOR. AGENT
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Phone
w w YitILLIP—'.1 D.
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State License� [/ S Approved
PLUMBING INSPECTOR J
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater11 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 Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stone Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee .4