51016.1 _,71733 I eeG.N0lG7 C-02-- COT NO.
NO. STREET'
LICATION FOR PLUMBING PERMIT
m a � CITY OF CUPERTINO
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anitary No.
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1/— Permit No S-1 0 / 6•
Pee S
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�* w ion i y made to the City of Cupertino for a permit to install plumbing
p pipes and/or
es listed on the reverse side hereof, and agrees to install said paces
nd/or GYtur m accordance with the provisions of the Plumbing Code 0 the City of
a w CupertiI " nd all other laws applicable thereto. .
~ ~ Use'y Premises iy E^-#C
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r 3 Owner L9.7 O rFs..�T Addresse-4Qoa
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3 CONTRACT , AGENT cp/4-�'
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a o State License ` Approved00,
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U , vV PLUMBING INSPECTOR
FIXTURES INUMBER MAIN DRAIN
Units Ifees 11Units Fees
Water Heater Size jef / .f
Water Closet Material
Bath Tub p To Curb
Shower To Pron. Line
Lavatories To Existing
Kitchenink 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 /Xy, /
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee /96
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Re]qef Valve Gas Fee
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Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total /fes Total Fee
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