51231.1 tyo61 I W0 )1V LOT NO. T
WW OF CUPERTIfI$EET
SEP j 7 CITY OF CUPERTINO
" < AP11CATION FOR PLUMBING PERMIT
w =
r o P A p Sanitary No.
R a �� � �l , 19
` Date Permit No ��/L.3% /
o <
3
wLL
Fee $ a3 •J0
0
� Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I 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.
wx
a Use of Premises PS I C� eA c Z
00
> w � Ci C l
3 Owner-SLG ( Address u1 �Cti
o nnnn /
B C�0� V C
IPl Address I(UIrV� UIP, )
3 � y 11r,CTORAGENT °
- w Phone 4
w z
Q tai State License Q"l� Approved/ WILLIAM D. EENEVICH
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet -,;;L Material
Bath Tub To Curb
Shower To Prop. Line v
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.S ink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size 3
Restaurant Sink Material p
Sand Trap TOTAL FEES
Urinal Fixture Fee 13, .-0
Area Drain Main Drain Fee UJ
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee T
Relief Valve 11 Gas Fee1- r
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 2 J
Total Total Fee 3. re7