NO PERMIT NUMBER 1'/-r'G,4 /DAJ L, LOT NO. s
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APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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x o Sanitary No.
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0 Application is hereby made to th LresCp 'Wi Ito install plumbing
o w pipes and/or fixtures listed on the �Side Herof)'�f5ti a sOto Install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all o��t//thyh�eer laws applicable thereo
Use of PremisesCITE' 01` CUPERTIIVO
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0 CONTRACTOR. AGEN are Sfr
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- W Phoned 9 F'—O SSG Sart Jose, California 95112
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u f State Licensel7 ► 5 3 Approved
<U PLUMBING INSPECTOR
JJPFIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS i FEES
Water Heater Size z' 1 660
Water Closet I Material C-
Bath 'Cub J ASOTo Curb
Shower .pQ 1 To Prop. Line
Lavatories A,QO I To Existing
Kitchen Sink A<V Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To MairLJm
Comb.Sink&'fray urb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size a I
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Thain Main Thain Fee .6 Qt
Water Leader Storm Drain Fee
_Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee �' sd