Loading...
51177.1 (2).z Lot No. A5 w APPLICATION FOR PLUMBING PERMIT CITY OF CUPERTINO � Q � ✓ Sanitary No. A m Dat _ C71 , 196/ 0 Permit No,S// % % o '(� r Fee 3 C P� 3 (�� s v�JApApplication 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 0 A in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other 'c laws applicable thereto. A o d A Use of Premises o U w o Owner c ro n By 3 y � Address 02 aS� % — --I(, State License ApprovedTLL'AM D. EMEVICH l\^ Plumbing Inspector FIXTURES NUMBER Units Fees WTub ter set smer osal Wash Tray Washing Machine Water Softener Bar Sink Comb.Sink & Tray Dental Unit Drinking Fountain Floor Drain Hopper Restaurant Sink Sand Trap Urinal WFilter A / O % Total MAIN DRAIN Units Fees Size Material To Curb To Prop. Line To Existing Not Conn, STORM DRAINAGE Size Material To Main Drain To Curb WATER SYSTEM Size Material TOTAL FEES Fixture Fee Main Drain Fee Storm Drain Fee Water Sys. Fee Gis Fee Permit Fee Total Fee