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LOT NO
NO. SIRE
APPLICATION FOR PLUMBING PERMIT
.W p y OF CUPERTINO
r o ® Sanitary \'o, SC'/' 3
3 J Date a - ,� � Permit No
Sio3. /
a
W LL Fee $ '5
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Ap tion s ier ,tO the City of Cupertino for a permit to install plumbing
o pipes �tirirre �-Tt`>2` verse side hereof, and agrees to install said rices
> a and/or fixtures to actor ante wi e provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
a Use of Premises
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O 0 �
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0 3 Owner f� t+f+�hhA,�,�ddress//��
J G y
J O CONTRACTOR,AGENT
625 Charles tree
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Phone
� San Jose, California 95112
oState License �'� '�3 Approved
�T 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 I Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing 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 S'27
Area Drain Main Drain Fee o
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee S—O
Relief Valve Gas Fee ,S'o
Vac Breaker
Skimmer
Filter
Permit Fee a 0 0
Total ..S.7,S-� Total Fee