1084 (2) LOT NO. '
NO. STREET
® FOR PLUMBING PERMIT
OF CUPERTINO
�16R 2 810 TY
Date , 195_ Permit No. O
CITY OF. CUPERTINO Fee $ 4 o 0
Application is hereby made to the.City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
J.
Use of Pr
�e
'a
fn Own at Addfess&La; r
By Address
C N CTOR GENT
Phone Approve
', Y/��'S6 PLUMBING INSPECTOR
rIX�URES NUMBER MAIN DRAIN
UNITS FEES II UNITS FEES
Water Heater S1Ze
�sets ii Material
Bath Tubs I To Curb I .
Showers To Prop. Line
Lavatories I To Existing
Kitchen Si nksr Not Conn.
Dish Washers
Waste Disposals "I
Wash Trays STORM DRAINAGE
Washing Machines I Size
Wabar Softeners I I' �� Material
Bar Sinks To Main Drain
Conib. Sink-a Trays To Curb - j1mmjL,,,,
Denial Units
Drinking.Fountainsi. it '
'Floor Drains WATER SYSTEM
r Hoppers I Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals i ii Fixture Fee 1 /. 00
Area Drains V, OOII Main Drain Fee .I
Water Leaders I I Storm Drain Fee
Sprinkler Varves I Water Sys. Fee
,I Permit Fee I /. O
TOTAL -TOTAL FEE V. 00
im