51068 ( V V1 LOT NO.
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
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3 a [).ate �>�1 � 1 iCCZ7196 Permit No
w Pee $
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o Appficati�n is)herebylmadet{ttor the City, of Cupertino for a permit to install plumbing
o pipes3ntl�or fiatu'reslh tei3t'on thei'reverse side hereof, and agrees to install said prices
i- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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O CONTRACTOR. AGENT
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aa State License C'3to �7�'H� Approved/ <
—U PLUMBING INSPECTOR (/
FIXTURES NUMBER MAIN DRAIN
UNITS1 FEES 11 UNITS FEES
Water Heater Size
Water Closet 17— Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories Z 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 To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee 7 S
Area Drain Main Drain Fee
Water Leader Stoam Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee / �o
Vac Breaker
Skimmer
Filter
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