51016.1 LOT NO.
NO. STREF,I'
fir cP Cuv�lrwOAPPLICATION FOR PLUMBING PERMIT
i AUG (� CITY OF CUPERTINO
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x o Sanitary No
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3 a Pat , I�/— Permit No �S �o �• �
U Fee S o�
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Application is hereby made to the City of Cupertino for a permit to install plumbing
`o s: pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws pplicable thereto.
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LL Use of Premises fS/1>G�t. Gem
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3 Owner �s/� Address
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O CONTRACT GHNT
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aoStte License�9
6.S%G Approved /
PIU MING INSPECTOR Z'//
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size .r
Water Closet Material
Bath Tub 2 To Curb
Shower % To ProD. Line
Lavatories To Existing
Kitchen Sink Not Conn-
Dish
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
Hopper Size ell
Restaurant Sink LMaterial
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
ReHef Valve GaR Fe,
5
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total O Total Fee