51088.1 (3) /D /O l LOT NO.
NO. $TREEI'
APPLICATION FOR PLUMBING PERMIT
ii 0 Y OF CUPERTINO
r a Sanitary No.
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o Dat 9f7Q Permit No.
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wLL Fees
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Application is he e City oC Cupertino for a permit to install plumbing
o Pipll'��/ortueverse side hereof, and agrees to install said prices
> : and 44' fixtures In accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
.. Use of Premises Spie wle-L6 -1
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/�`— PLUMBING INSPECTOR
FIXTURES INUMBER MAIN D RN
Units Fees nits Fees
Water Heater Size
Water Closet I E efiterikN
Bath Tub o Cu
Shower To Prop. Li
Lavatories To E
Kitchen SiA ! nn
Dish Washer
Waste Dis
Wash Tra 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 TrapTOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stonn Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Fe",
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee •-00
Total doTotal Fee