51089.1 (13) No. Street Lot No.
o —
d APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
0
U ary No.
c L1
E Date G—a ® ermit No.
0 ] t S 1 ry Fee S
r Application is hereby made to the City of Cup r'im �l'dYa p i6 o install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
0 in accordance with the provisions of the Plumbing Code of the Cit (o�f Cupertino,and all other
'c laws applicable thereto. j�3.1 f',_ ' t I , U
Use o(Premises 1 O
° Owner AAWM Us S G Address
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vt By Address ��Dtv •\r`L�K�T
3 E ^ Contractor,Agent \ p
Phone
A 3
A
— -a State License Approved
P umbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower 'ro Prop. Line
Lavatories To Existing
Kitchen Not
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 G
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief V,Iye Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee a
Total °% Total Fee cC