HomeMy WebLinkAboutNO PERMIT NUMBER / 0203 I ��� 1-, AV¢ LOT NO.
NO. STREF.I'
� L�TION FOR PLUMBING PERMIT
d I Y OF CUPERTINO
z i
s SanitaryNo.
p ° /NOV �n 168 _
0 a Date 196_ Permit No
3u �O
4 Pee $
s o --p�er� Q(�oF[n
CApplical7dn is �� ty�the City of Cupertino for a permit to install plumbing
`o 1 Pipes and/or fixtures Itsied t I e reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provi ions of the Plumbing Code of the City f
<w Cupertino, ane ws applicable reto.
LL Use of Premis �QK
00
3 Owner
Address
0
zz J
z ]3 Address
O CONTRACTOR, AGENT
3 �
— Phone
w z
0 w
0 s Slate Licens
a 0
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS PEES
Water heater Size
Water Closet Material
Bath 'Cub 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.SinkBTray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Thain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Cas Fee
Vac Breaker
Skimmer
Filter
4J
Permit Fee
Total Total Fee