51167.1/JL.J ! �LCGflC7J LOT NO.
NO. STREET'
s qPA PLICA ION FOR PLUMBING PERMIT
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W<i Li/ C_=-� rITY OF CUPERTINO
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r O ��!� I rJ 19&7 '�� .. Sanitary No.
o a Date 1962 Permit No
" r.tTv. OF r� ipFQrl�;'� Fee $
° Applicat�oMis hereby made to th'e City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
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and 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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State License �9��J� Approved WILLIAM D. 13ENEVICH
PLUMBING INSPECTOR
FIXTURESNUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
/
Size
Water Closet
Material !i/
Bath Tub
/
To Curb
Shower
To Prop. Line ✓
Lavatories
To Existin
Kitchen ink
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 )
Area Drain
Main Drain Fee — )
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee aZ�J
Total
// /�;$(/
'Total Fee sCI