51001.2 LOT NO.
NO. STXEEI'
APPLICATION FOR PLUMBING PERMIT
z a C�IITY OF CUPERTINO
ro Sanitary No.
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o a Da — � � ��. 19(>0 � Permit No SlOCJ/ • •2-
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wLL Pee $ 7.
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Application is hereby madetothe City of Cupertino for a permit to install plumbing
o r pi�qq. �rS� /,ir-A't{{-xt�s�� I�1ttie, reverse side hereof, and agrees to install said prices
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anLY�cir xtMr!s in`*att� d 'the provisions of the Plumbing Code of the City of
a) Cupertino, and all other laws applicable thereto.
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3 Owner 7i7 Addres M fE�/% ✓56 A',OZL�"Yl,
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3 y CONTRACTOR, AGENT
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WW State Lic
o s ense J�S -s �n Approved
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-U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
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&Tmy To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TO'T'AL 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
Permit Fee 2,OF
Total Total Fee