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CRY OF CUFcRTNO CITY OF CUPERTINO
Z -< APPLICATION FOR PLUMBING PERMIT
r o SEP 1719 1 Janitarv, No.
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� Application is hereby made to the Cit}' of Cupertino for a permit to install Plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 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.
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Use of Premises
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3 Owner Address Xa nn GCti C I CX f
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By x, I -L Address YVt�
o CONTRA TOR, AGENT
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0 Phone — YtJ
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a o State License G, U XApproved WILLIAM D. SEhEVICH
U \/ /, PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size
Water Closet 2 Material
Bath Tub To Curb
Shower I To ProD- Line
Lavatories 2 To Existing
Kitchen Sink 1 Not Conn,
Dish Washer
Waste Disposal '
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink I To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material CAU
Sand Trap TOTAL FEES
Urinal Fixture Fee 3.
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee Q
Relief Valve 11 Gas Fe
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee . 01)
Total Total Fee 3.