51231.1 )aj7 I WtKsv4 CfaK C-L' LOT tin. 7
NO. STREET' l -1
CITY OF CUPERTINO
< Cin OF CUHAPPLICATION FOR 'PLUMBING PERMIT
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o a' Date 19 11 Permit No
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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
I 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.
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Use of Premises lC-P lC P �.�
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O CON ACTOR, AGENT
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s State License) CC26 jq� ApprovedWILLIAM D. BEiVE\rICH
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X PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater 1 Size
Water Closet 2 Material
Bath Tub To Curb
Shower To Prop. Line c/
Lavatories 2 To Existing
Kitchen Sink Not Conn.
Dish Washer
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 Tra TOTAL FEES
Urinal Fixture Fee SCj
Area Drain Main Drain Fee a7
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Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee U
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee rJ.)
Total Total Fee 3, J t]