NO PERMIT NUMBER (3) LOT NO.
NO. VF "D
APP � y�g PERMIT
wztYT 0 C IDC&TI
Y.o Scott . ry"\o.
o Date September _ �8 Permit No
3 U .� ! 1 llr �UPERTWO Pee $ o7 3• SZ
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o Application is hereby made to the City 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
r 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.
Use of Premises j')Hel Dwelling
ng
0 0 7�� 2 5 De!IU Cruz Boulevard
3 OwnAtz Crane Compal Address
oL s Palm Plumbing Company L Sunnyvale-Saratoga Rd.
ss
2 O y CONTRACTOR, AGENT
3
245-2323
— z Phone
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Ww ba.�!u.:.: o. : ravlcrl'
a2 186579 State License Approved
PLUMBING INSPECTOR
4l.]
FIXTURES I NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closet 2 Material
Bath Tub / To Curb
Shower / To Prop. Line
Lavatories 1 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 TO'T'AL FEES
Urinal Fixture Fee 13,561
Area Drain Main Train Fee I—
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee /5-0
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total / ,.f Total Fee