NO PERMIT NUMBER LOT NO.II
NO' STREET
APPLICATION FOR PLUMBING PERMIT
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o Date Permit No
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LL wApplication is here�ylm4�e tj�hetqity �u {�i o for a permit to install plumbing
o F- pipes and/or fixtures listed on�tlie rev�a i8e014,1 j, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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0 Use of Premises
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J 'LB;�.c�f7> \ '..�M <) - Address �a--^-�'`�
O CONTRACTOR, AGENT
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a a V!ILLI.a:vl D. E=Pd=NIGH
'' IIa o State License Approved I /
11'� PLUMBING INSPECTOR r�
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater rZterial
,Water Closet C
Bath Tub rb
Shower . Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Dis rs
WashT STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain 11 WATER SYSTEM
Hopper Size
Restaurant Sink Material(p /U
Sand Trap TOTAL FEES
Urinal Fixture Fee —0
Area Drain Main Drain Fee G
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee a $'O