511791 '661' -e_ LOT NO.
NO. S EEl'
APPLICATION FOR PLUMBING PERMIT
" d CITY OF CUPERTINO
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Sanitary No.
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r Application is hereby made to the City of Cupertino for a permit to install plumbing
i �or��{{I�..tturppii��467�{rd�jt� 11r�7���f�/�{�,,everse side hereof, and agrees to install said noes
o andG�tlftkhlkkrn AutJ�R'IN I�Vne provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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3 CONTRACTOR, AGENT
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I u z State License. �` 7 �z 0� Approved
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O PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS 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 Troy.
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
Total
Total Fee