51043.1 (16) "Patm m I/&ee .4 • LOT N11 a"64
NO. 5
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO p
x o G Sanitary \u. 'SQL'O
Va Date g Permit No
3�
W LL IAPR 12 1868 Fee $
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Application is hereby made to the City, of Cupertino for a permit to install plumbing
o rw- pipes ani1or fixtures I t ��(b�,r�verse side hereof, and agrees to install said rices
a and/ �C�x�ftre a� i provisions of the Plumbing Code of the City of
a w Cope ani
an all of ler laws applicable thereto.
~ Use of Premises � S
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3 Owner&4AeV Address
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By bZ!�q
3 F CONTRACTOR, AGENT Cha�ar est
— < Phone V?T-o.S—r6 San Jose, California 95112
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aoState License Approved
U PLUMBING INSPECIOA
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Water Heater I 11size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener J7 Material
Bar Sink To Main Drain
Comb.Sink&Tra 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 Storm Drain Fee
S rinkler Valve Water Sys.Fee S
Relief Valve Gas Fee ,Sll
Vac Breaker
Skimmer
Filter
Permit Fee Zcz
Total 6 Total Fee,