100226 / ♦7� 1 . LOT NO.
NO. STREET I
IST
ION FOR PLUMBING PERMIT
N a
CITY' OF CUPERTINO
wz - —
x o Ipplication
Sanitary No.¢ /°° 2.2G
3e �, 19�� Permit NoaU3 .. '([1tl`� Peeitoi° a a e to the City of Cupertino for a permit to install plumbing
o a pipes and/ fix listed on the reverse side hereof, and agrees to install said prices
and/!�firs in accordance with the provisions of the Plumbing Code of the City of
a w CO and all other laws applicable thereto.
w 2
< r
a w Use of Premises _ t/�4/Ggy`d✓s . �CF
0 0
> w �.
a a Owner
Z J 4-
z B ress • T
O CONTRACTOR, AGENT
3 w Phone �L 97 — sKlO 7
w z
w w �
uf State License. 0237 5'Off ApprovJ�
PLUMBING INSPECTOR
FIXTURES INUMBER I MAIN DRAIN
Units Fees Units Fees
Water Heater size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
_Lavatories 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 Trap TOTAL FEES
Urinal Fixture Fee r
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve 11 Gis Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
eGo .F,ri°iftc —
&nl! ,
Permit Fee
Total Total Fee . �f