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APPLI ATION FOR PLUMBING PERMIT
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Z ^• Y OF CUPERTINO
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Sanitary N0. So0
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3 < Date - •�— 6� Permit No
w U Pee $
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' o Application is hereb In t City of Cupertino for a permit to install plumbing
0 i c r ur verse side hereof, and agrees to install said rices
and rJi R�ltlun nitancc w" ith the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
LL Use of PremisesS
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oOwner 441 A-A.E✓�,ff;,f ,,'rr,DAddress
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j CSe"ice Co., 9,w
J O By CONTRACTOR, AGENT 625
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3 0 Phone 29�o ssz. San Jose, California 95112
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u f State License X7/537 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 12, To Existing
Kitchen Sink Not Conn.
Dish Washer 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
I lopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee S-v
Area Drain Main Drain Fee
Water Leader- Storm Drain Fee
Sprinkler Valve Water s.Fee a
Relief Valve Gas Fee 5'a
Vac Breaker
Skimmer
Filter
Permit Fee '!),aQJ J
Total 7k Total Fee rJry