51179c
0
3 r
W
/oto
No. Street Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Cffy
Sanitary No.
9te%per-;,cL IJ,LN�O , 1 %/ Permit No. 'S //75
^ I D Fee$ SS-21
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.
Use of
Owner
By
Phones /' 3 70
State License 6 7
�-
Address /d 20J-(-6r`A-of-.E:,
Address 79H7 "I/�T%�:��i
Approved"�'a,d6faLC'
e Plumbing Inspector
NUMBER
MAIN DRAIN
Units Fees
Units Fees
ter Heater
Size
ter Closet
Material
jFXTURES
h Tub
To Curb
ower
To Pro . Line
atories
Tochen
Sink
Not Conn.
Dish Washer
Waste Disposal
Wash TraySTORM
DRAINAGE
WashingMachine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand TrapTOTAL
FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve I
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee _ , p