NO PERMIT NUMBER (3) / �U/Cl 1 I/lfJ_�CG� /1 iIwKY "-ice LOT NO.
NO, STREET
APPLICATION FOR PLUMBING PERMIT
C:WY OF CUPERTINO
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Sanitary \o.
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0 a Date S 7 Q 96 Permit No
3
w LL Fee $ 404 4V74
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w (Application-is Ian{y�g�n ft(,��e City of Cupertmo for a permit to install plumbing
0 r- pipes grid/dr'�xtdtclsllisheii. hdIthe reverse side hereof, and agrees to install said prices
r a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and of laws applicable thereto.
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oa 0 ��.�.�� /--//G2'.n�C-�/ Address�//lL� -,-� —
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0 CONTRACTOR, AGENT
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- 0 Phone 7 J .
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rc a yyI LLLAM O. F.IiN'tVICH
u I State License r-22�S3�r Approved
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n U PLUMBING INSPECTOR
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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 5ink 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 Foantain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES f�
Urinal Fixtare Fee
Area Drain Main Drain Fee . 00
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee Q
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
do Permit Fee 3•a''
Total Total Fee