51038 LOT NO.
NO. STREET'
m d CRY OF CUPERTINO
CITY OF CUPERTINO
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z A C�7 PPLI/C,ATION FOR PLUMBING PERMIT
E ¢ OCT `t �"• 7 Sanitary No.
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o < Date 197 Permit No ..S
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U Fee $
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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0 LL Use of Premises
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, 3 Owner
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By Addres.
J O CONTRACTOR, AGENT
3 ` ��7 - X713
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a o State License Approved
U PLUMBING INSPECTOR ,/
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater sD 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 Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee ,D�
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve (3—Fee
Vac Breaker
Skimmer IAb
Filter ISb
Pool Sweeper
Permit Fee
Total Total Fee ��