21187 P(���� I -• V DC7//I� LOT NO.
NO. STREF.I' '" tF
APPLICATION FOR PLUMBING PERMIT
" < CITY OF CUPERTINO
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xo Sanitary No.
o
JIII Fees
Date`` Sanitary
No �/ 7
3U � j 3sa
o AppficatlidDRi, 1'1reb19m8de to the City of Cupertino for a permit to install plumbing
0 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
a and/or fixturesk arcor4n•e-%ithlthe provisions of the Plumbing Code of the City of
a U) Cupv iof and�Ill oti law sl applicable thereto.
~ Use of Premises
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aYl ��11i (/ Address
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Owner
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z sy O�.O�, i Address ✓
O CONTRACTOR, AGENT'
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- Phone �` 5�5 —07L
w w /) WILLIAM D. 3``N-RICH
o a / �`/ Approved
o State License
—U PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closet ?� Material
Bath Tub / To Curb
Shower / To Prop. Line
Lavatories 2_ To Existing
Kitchen Sink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink 11 To Main Drain
Comb:Sink&Tray To Curb
Dental Unit
='Drinkin Fountain
Floor Drain WA'T'ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee I-0—ry
Area Drain Main Drain Fee u3vv
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee /,szl
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee 1:7-31re