51192.1No. Street Lot No. O
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LICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
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U I �� �� 1 1970 Sanitary No.
Date
00 19f V Permit No. i/ Vi .
3 CIT 1�/ OF Fee Sy-a-
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
'E laws applicable thereto.
m ;, Use of Premises
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° Owner I,/ ��iV.s �/ Address
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Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water HeaterSize
Water Closet a
ST
Material
Bath Tub
To Curb -
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
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 Trap
TOTAL FEES
Urinal
Fee
Area Drain
IFixture
Drain Fee
Water Leader
Drain Fee
Sprinkler System
r Sys. Fee
Relief Vnlvp,
11 Gaq Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee 'n