NO PERMIT NUMBERf?C'SEP
�APPLICATAT 25 IS68
LOT
;?FOR PLUMBING PERMIT
Y
OF CUPERTINO // Q
Sanitary No.
F
Date rr196— Permit No
:T J
( t \ (Ir �i ll "-iTWO Fee S 7—
Application
Application is hereby made to the City of Cupertino for a permit 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 provision of the Plumbing Code of the City of
Cupertino, and all otherlws applicable th
Use of
Owner
k
State License ---2 C 7S
Approve ,
PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To ProD. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
"T'a Curb
Dental Unit
'
Drinking Fountain
Floor Drain
WA'T'ER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Train
Main Drain Fee Q
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Permit Fee
Total Total Fee
Total1 7.06