51143 (2) g7lm I tIA 'V' LOT NO.
NO. STREET
CITY OF CUPERTINO
OF CUPMM
z APPLICATION FOR PLUMBING PERMIT
Sanitary No.
rcLL M V h7
0 �i Date , 19 Permit No
3 `
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PAID Pee $--4
1 LL
o Application is hereby made to the City, of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> f 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.
Use of Premises N S T
00
> 0
3 Owner4o�t i.4 ATC 4 /t1C'0%-/4LAddress 2 70 V C S 5 A � L'
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O CONTRACTOR, AG ENT
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— Phone2 5 1 7 / 5 y
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co State License 2 S S o 20 Approved
UiI PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
Lavatories xi tin
Kitchen Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee Ass
Area Drain Main Drain Fee
Water Leader Storm Drain Fe
Sprinkler System Water Sys. Fee
Relief Valve 11 Gaq Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee 7.