NO PERMIT NUMBER / v y u 2 I 4L-J LS>T
NO. STREET
APPLICATION FOR PLUMBING PERMIT
W ' QTY Ufbf
wzqo < Date lY hg� No
3U CY 0 968Fee $ (�?(o•j—o
W_ LL
0
� Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
`o 1- pipes and/or fixtures Iiste(PffXhe r i-ersQ�$i $ t agrees to install said prices
and/or fixtures in accordance`with [6e PIG 211std(t hhll'Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
., Use of Premises
00
3 Owner-�. � /7JG�h�r trJ Addres$��"P�
0 z By �vO .�C� \1L�� �4 Address
O CONTRACTOB, AGENT
3 `m Phone
w w WILLIAM D. 6=NEVICH'
a o State License,'? Approved
-U PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material e
Bath Tub To Curb
Shower '10 Prop. Line
Lavatories To Existing
Kitchen SinkNot Conn.
Dish Wnsher Sewer Box
Waste Dis os
Wash Tra—y STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.SinkRTray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYS'T'EM
Hopper Size
Restaurant Sink iMaterial
Sand Trap T AL FEES
Urinal Fixture Fee
Area Drain Main Train Fee Scc
Water Leader Storm Drain Fee
Sprinkler Valve Water s.Fee •J
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee „J