51231.1 cLot No.29
9 CITY OF CUPERTWOStreet
WATER DEPT..
d APPLICATION FOR PLUMBING PERMIT
—o—AUG 91971 1 GI-T-Y-OF GUPFRTINO
PAI ®
Sanitary No.
c /
F Date 29 , 19V Permit No. ,5�/�-:3//
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0 Fee S.2-
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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A 'n Use of Premise
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OwnerAddress
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o rn By G Address
3 r Contr tor,Agent
o Phone
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— � State License Approved
1I -)±5— Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units I Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
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 I Size 3
Restaurant Sink Material ,7
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee l�
Relief Valve Gm Fee
(. S
Vac Breaker
Skimmer
Filter
RPcmiffeel
2-UJ
Total Total Fee . ('�