Plubming ApplicationN Q
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e%APPLIC�ATId FOR PLUMBING PERMIT
CITY OF CUPERTINO
UG12 6� Sanitary No.
Date 196-5 Permit No q
Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises ';�L S
Owner— Q �T S Address
By (,'pnilta[ �,aknLc� CD•. 9Kc
CONTRACTOR, Address
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Phonea98-oss6 San Jose, California 95112
State License �7)s 3� Approved WILLIAM D. SENEVICH
XPLUMBING INSPECTOR V*'
FIXTURES
NUMBER
0/8-A�MAIN DRAIN
UNITS
FEES
I UNITS FEES
Water Heater
I Size
Water Closet
.2—
3.00
Material
Bath Tub
/
5V
To Curb
Shower
/, d
To Prop. Line
Lavatories
3
41,50
To Existing
Kitchen Sink
/
/.SD
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/
.$D
Size
Water Softener
Material
Bar Sink
To Mai in
Comb.Sink & Tray
T urb
Dental Unit
'
Drinking Fountain
Floor Drain
WATER SYS'T'EM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee /
Vac Breaker
Skimmer
Filter
Permit Fee Od
Total
O
IS;
'Total Fee ,��