51075.3 (4) /OC/00 /V. 19n { au Ave (Vg0e, 96k)
LOT NO.
NO.. STFEr.T�-
APPLICATION FOR PLUMBING PERMIT
z < CITY OF CUPERTINO
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° Application is hereby made to the City of Cupertino for a permit to install plumbing
`o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r : and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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LL Use Of Premises
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3 Owner ,o.l n'�.�rSl Address
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z p_ VVAA- .C.att� �� tr u�•-.tr4r-{'fur Address es
J ° y CONTRACTOR, AGENT
– am Phone 3 ifs— 9 1 G� x.V 03
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f ,$tate License Approved
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-U PLUMBING INSP OR �/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater 1 150 ISize
Water Closet ,i ,-6V Material
Bath 'rub To Curb
Shower 2x',00 To Prop. Line
Lavatories To Existin
Kitchen §ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tra STORM IN
DRAAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
DrinkingFountain
Floor Drain a e WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand TrapTOTAL FEES
Urinal ,Ba Fixture Fee co
Area Drain Main Drain Fee D
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee -60
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
wta c�iN4 j6
Fv c kJ¢ 150
�aF *WJ ' OO Permit Fee 0D
Total ;04 Total Fee r.�,