51167.1 Plumbing Permit LOT NO.
_ NO. STREET
APRUCA ION FOR PLUMBING PERMIT
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',�G CUPERTINO
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3 Sanitary No.
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_ Fee $
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Applif3Pdlis h't,Rby�m:rd-q��t!qq��tt{{ RCt��Cyi' of Cupertino for a permit to install plumbing
o pipes and%or fixtures hstt-d�d.Fb reyF e side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i W Cupertino, and all other laws applicable thereto.
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2 4 Use of Premises
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3 Owner �i G Addrreesss/./y//•
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C*ONTRACTOR, AGE
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d WILLIAM D. GENEVICH
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—0 T PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES
UNITS FEES
Wateri-feater I Size
Water Closet Material
Bath Tub 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.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee Z--tX2D
Area Drain Main Drain Fee V
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee Irell—
Vac Breaker
Skimmer
Filter
Permit Fee of --e)
Total Total Fee