NO PERMIT NUMBER (3) �O J/ I / L� C14- LOT NO. /OIJ
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z d CITY OF CUPERTINO
W
s o Sanitary No.
3 a f'��� Permit No
U �1 661, r
Fee
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�1�plication is her y_made to the City of Cupertino for a permit to install plumbing
o 1 Ptpes arldf9nfixtures listed on the reverse side hereof, and agrees to install said prices
> and%or -fixtu 4nlaccordance with the provisions of the Plumbing Code of the City of
a w Cupertir a Il qt,& laws applicable thereto.
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LL Use of Premises n,cr i46.6.n 1Z�
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o < Ownerl,� -><+Cy-�—� �"U' 671' 'Address
zBy Address�J
O CONTRACTOR, AGENT
3 X293-8O 7 7
— `0 Phon
wz
U ° �3�5 -3 Approved
< o State License
�c} -V v PLUMBING INSPECTOR (/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES
UNVS FEES
Water Fleater Size !/
Water Closet Material
Bath 'Cub To Curb
Shower / To Prop. Line
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Dis os
Wash Tray— 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 Material ,c.0
Sand Trap TOTAL FE
Urinal Fixture Fee
Area Drain Main'Drairr Fee 5-O0
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee .SD
Relief Valve as Fee
Vac Breaker
Skimmer
Filter
Permit Fee &)–&-O
Total Total Fee