51137 lo3O7I S0l7C2SFT Ci. LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
.W Z DEC� CUrZZ.nNO CITY OF CUPERTINO
a p li Sanitary No.E z (� ,/ ?
p a Ute 14 ,i77Y �— �Z 19.KL Permit No. . - /�7
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3 LL Fee $
10
Application is hereby made to the City of Cupertino for a Permit to install Plumbing
01 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 !/J
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r 3 Owner r Address
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J z By �/-Ct /..QQ4 �ll�u-�tt//14,llue-w-w(Address T 7G A�C12V/70. 7 4 v
O NTRACTOR, AGENT
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- Phone?S 7 - F-/ 0
ao State License—2 3 7 90 Approved ado
U `� , PLUMBING INSPECTOR
FIXTURES INUMBER 11 MAIN DRAIN
Units Fees Units Fees
Water Heater ,o'b Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
Lavatories To Existing
Kitchen Sink Not C nn
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
Ho er Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee r '�o
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Gw�Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee Z 0c)
Total Total Fee ,.��