51187.a
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LOT NO. "11/
NO. Z t SPWEEI a a
APPLICATION FOR PLUMBING PERMIT
'CITY -OF CUPERTINO
Date
H n ,
Sanitary No.
Permit No5���
Fee $ 07 3'S�
Application is hereby, fade-to-tge�Citty of Cupertino fora permit to install plumbing
pipes and/oi/fixtures Itstedi ,$t he 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 uthe�r, laws applicable thereto.
Use of Premises
By CONTRA TOR,AGENT
Phone�S
State License��5�7�
Address �G
Address
VVILLIAIY D. DEtVc,/lCK
PLUMBING INSPECTOR
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FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water heater
/
Size
Water Closet
-3—
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line ✓
Lavatories
1
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&Troy
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
I Main Drain Fee
Water Leader
Sloan Drain Fee
Sprinkler Valve
Water Sys. Fee /
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
.—
'Dotal Fee