51016.1 �7 ^s0_F LOT Nle
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NO.
�o� ;t APPLICATION FOR PLUMBING PERMIT
i z _p „-,� CITY OF CUPERTINO
1 Sanitary No.
3 a D1te r l�C Permit No —/ Q / G. /
U Pee $
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0 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
> 1- 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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j a Use of Premises
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r3 Owner .Gt�ivQ 6L�t?' Address
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J , By /Q�,9 a-rt r•1 z �O E Address"e?ef
O CONTRACT , AGENT
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— 0 Phoneme
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0 Y. State Livens 60S.-Z�D Approve
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—U q' PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet 7 Material -i
Bath Tub To Curb
Shower / To Pro . Line'-'
Lavatories To Exktin
Itchen Sink Not Conn
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine / Size
Water Softener Material
Bar Sink I To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size /
Restaurant Sink Material zzv.
Sand Trap TOTAL FEES
Urinal Fixture Fee ( ;
Area Drain Main Drain Fee
Water Leader Storm Drain Fee _
Sprinkler System Water Sys. Fee
Relief Valve GA�Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee