51001.2 (3) /0 3F7 I Al<STi9 S�
LOT NO.
NO. STYEF� �
RJCAIIO`N FOR PLUMBING PERMIT
lbtT,Y OF CUPERTINO
r a ?NIAR 28 0 1 Sanitary No.
3 < Date 196— Permit No �•
2 LL
CITY OF CUPERTINO Fee $ 9
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o a 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
a w Cupertino, and all other laws applicable thereto.
w 2 \ �/ (/ W/
LL Use of Premises 1
00
i3 Owner/ ��+- 1/,-/�7�� ��///^f Address/o✓O / Al�f7T�)i�//iAf�V��C
O J y _ . / /1 ta:6' (a-Gres 2e
Addres. A lhr/fJ
3 CONTRACTOR, AGENT
w i Phone 7yy1 /3,
�„1�U — o< iO � Approved l� I
a o State License /
—r0 PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Beater I ISize
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories 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 11 WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker /
Skimmer /
Filter
L
Permit Fee too
Total Total Fee . O