NO PERMIT NUMBER (2) LOT NO.
NO )/J STPEF.T�1
AQP LICATIO�N FOR PLUMBING PERMIT
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o j - 196— Permit No
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� Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
o 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
<w Cupertino, and all other laws applicable thereto.
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LL Use of Pre 'ses
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O TRACTOR, AGENT
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ao state License Approved `
PLUMBING INSPECTOR (/
FIXTURES NUMBER MAIN DRAIN
UNITS1 FEES UNITS FEES
Water Heater pP-p-
Water Closet Bath Tub Shower �• ne
Lavatories 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 'POTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader- Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee A 0
Vac Breaker
Skimmer
Filter
Permit Fee Q
Total LTotal Fee