NO PERMIT NUMBER ►g9� y llJ+�ea+e��ZLOT NO. d
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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x o Sanitary No.
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Application is hereby made to c ����66y�}{ Cuperti
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`o 1 pipes and/or fixtures listed on t �`'e� eF'sid��Ne Qq��{{jjjjand a s to install said prices
r and/or fixtures in accordance with the provisions !1"'fMe P( g Code of the City of
a w Cupertino, and all other laws idcable thereto.
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Owner �Atdpd�yt�sso
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By I
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CONTRACTOR. AGENT
�s—s San Jose, California 95112
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State License/74.53,2 Approved
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PLUMBING INSPECTOR
LJA FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater Size " .00
Water Closet Material ..'L
Bath Tub To Curb
Shower / To Prop. Line
Lavatories 3 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 Dr
Comb.Sink&Tray Tosutb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size // /,o
Restaurant Sink Material f)l. '
Sand Trap TOTAL FEES
Urinal Fixture Fee -$
Area Drain Main Thain Fee .S "5
Water Leader I Storm Drain Fee
Sprinkler Valve Water Sys.Fee Q
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee q 6 d
Total /0 /5.00 Total Fee T nQ