51001.2 01 6 IJ��!X-�r� L ilii , LOT NO.
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
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TY OF CUPERTINO
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3 a Uate✓✓ j Jt y lyo / ':IQ6-7 Permit No. .SJ/
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i 4 Pee $ 46 ,ry
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipe3'TnV/oflfiztu�2s O ' �i'IMeVeverse side hereof, and agrees to install said prices
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and-/4 fixturest in ac ord�r e wlilh the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
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Use of Premises
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o a Owner Address l� _rye/
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C N7RACTOA, AGENT
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- 0 Phone-
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a a a V1rll I_Inaq n.
'I Q o State License 3 c/3i� Approved
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_U PLUMBING INSPECIORlp-
FIXTURES NUMBER MAIN DRAIN
UNl S FEES UNITS FEES
Water heater Size
Water Closet j' Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen ink 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
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
14J42—
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee p
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee . OD
Total Total Fee 3L