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CITY Of CUPERTIN0 JO`�
J U L 21 1971 APPLICATION FOR CITT/Y OF CUPER TINO ING PERMIT
P A I D Sanitary No.
Lot No. 0-
Date , I Permit No.
Fee$aa-S-Z)
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
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto. /,,—) .
Use of Prvrm /
Owner
By
�
�Com
Phone �7✓
State License
Approved /
Plumbing Inspector
FIXTURES
NUMBER MAIN DRAIN
Units Fees Units
Fees
Water Heater
Size a
Water Closet
Material �..
Bath Tub
To Curb
Shower
I 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
Size 3
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee I 1
,Vo
Area Drain
Main Drain Fee
. OJ
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee I . T O
Relief Valve
Gas Fee
SO
Vac Breaker
Skimmer
Filter
Permit Fee
. JJ
Total
Total Fee
SO