NO PERMIT NUMBER (3) /O 1�4P P' I cel LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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o j Date l•T it No
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196
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o 1- pipes and/or fixtures I { �n tyre jftand agrees to install said prices
>a and/or fixtures in acco 1� c w thei [� Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
LL Use of Premises
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Owner
X, 06G f Address
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oz By W/wz-X� 5 �G69, Address 1Z 1,7
J o CONTRACTOR, AGENT
3 < -3 'K- 7G15
— z Phone
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u syL�36— �/d —Z}5 A roved WILLIAM D. BBiSEVICH
State License pp
a U PLUMBING INSPECTOR v
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink 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
Area Drain Main Drain Fee
Water Leader Stolm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total 11 Total Fee