51046 � k4� LOT NO.
NO. STIIEF.i'
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
z
x o Sanitary No.
o a Da 196 Permit No
3 4 I rr�} 7 Fee $a 7
o A itajt 0sth�J99de e City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r I and/or fixtures in c he provisions of the Plumbing Code of the City of
a w CUU11 ao�ll cl � able thereto.
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a Use of Premises
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3 Owner-\ Address
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� z By /I �i S 'R r6 �VrO • TriC Address ROO -De GC V
3 H CONTRACTOR, AGENT O 1 v
m Phone ril9 b —S Z6 7 D
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rcasState License
l Y �� Approve /U/
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PLUMBING INSPECTOR
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 I Storm Drain Fee A
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total 'Total Fee a 7