511672/6I 2 I ( V/4em 4f At;- LOT NO. 2-C
NO. STREET
APPLICATION FOR PLUMBING PERMIT
Uj 1 CITY OF CUPERTINO
Elm Sanitary No.
o a Date 196_ Permit No
3� Pee9
so
Application is hereby made to the City of Cupertino for a permit to Install Plumbing
o r 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
a w Cupertino, and all other laws applicable thereto.
~ Use of Premis O O
J 4
>W GGi l id/2 oon,► r
0 3 Owner Addr ss
/� Addc'I
o By � �` r Address i z
_ CONTRACTOR, GE an A0J
— m Phone 3 `
ao State License / O �3 Approved /
U �( PLUMBING INSPECTOR
l'� V
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNrrs FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
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
HopperSi
ze
Restaurant SinkI//s,
Material
Sand Trap
TOTAL FEES
UrinalFixture
Fee 0
Area DrainMain
Drain Fee
Water LeaderStorm
Drain Fee
Sprinkler ValveWater
a. Fee
Relief Valve
Gas Fee
Vac BreakerSkimmer
Filter
Permit Fee
Total
D o
Total Fee 1-0