5935d67 6 U I trt./li{..�-�/c� W��A-•i _ LOT No. /
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
DSanitary Nu.
1 O 196- Permit No
68 Pee $ zl�
Alication is hereby made to the City of Cupertino for a permit to install plumbing
n fiiQiltl�e�1 I I the reverse side hereof, and agrees to install said prices
an or re�s{{..�INN c i>��th the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
By /,/_�/ Pc
CONTRACTOR, AGENT
Phone-�,��n� � 1� f
State License -2,d7-s J
Address1-7 17.1 1D
ApprovepILLIA;Ii D.
I' - U PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Beater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tra
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.SinkR'I'ray
'I'a Curb
Dental Unit
Drinking Fountain
Floor Drain
WA'T'ER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee