51001.4 a� ►� y i 1r. ,1�:�,.a LOT NO.
NO. TySTREET
APP-LICA-TION TOR PLUMBING PERMIT
z d ITY1 OF CUPERTINO I
x JUL 2 6 19� I+� Sanitary \'u,
p LL
o Dare 196�yy Permit No �
Fee S -:2(10'j—D
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
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LL
Use of Premises
3 Owner
Fno 1.l k C142Addres -ter'
z B;/ AddressL_/
J O CONTRACTOR, AGENT �
3 �
Phone _J-077
LL State License oZ c7�� Approved
a
PLUMHlNG INSPECTOR
FIXTURES j NUMBER MAIN DRAIN
UNITS1 FEES 11 UNITS FEES
Water Ileater Size
Water Closet RNotConn.
Bath Tub
Shower Prop.
Lavatories
Kitchen ink Dish Washer
Waste Dis o al
Wash ra STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tmy To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Materialcj.,Jt
Sand Trap TOTAL FE S
Urinal Fixture Fee
Area Drain Main Drain Fee J •�
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �..�
Total Total Fee