51187LOT NO. %J
APPLICATION FOR PLUMBING PERMIT
11 �ILw'
Y OF CUPF.RTINO
�q, Sanitary No. SJJ'SDace / - . iq 8196 Permit No SZt k 7
Pee $ �2 �- 0
Application ,.�s-hereb Itt>^ydc%;Rh�City of Cupertino fora permit to install plumbing
pipe{vnTyor rfix'furesati�fcr411the 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
Cupertino, and all other laws applicable thereto.
Use of Premises
aa:
OwnAd
�Ad
CONTRACTOR, AGENT
Phone
State License Approved WILLIAIt9 D. GEtiEVICH
PLUMBING INSPECTOR
X,
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 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
Total
//
Total Fee a Ira