51038 /a 3 a C'
No. Street Lot No.
o —
m APPLICATION FOR PLUMBING PERMIT
(W tUPFATWO CITY OF CUPERTINO
0
v Sanitary No.
JUN 1..
.E Date ('� � , 19\ 71 Permit No. 4,3k
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P A D Fee$ .?
0
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
0 d in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
cc laws applicable thereto.
A o
m ro Use of Premises
' Owner Address
0
° «
Cupertino Plumbing
h By Address
3 Contrac
„ o Cupertino, C¢. 95014
3 Phone
- '; T� 2tl
State License Approved
Plumbing Inspector '�
CFIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
er r Sb Size
t Material To Curb
7'o Pro . Line
Lavatories I To Existin
Kitchen Sin N C n
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
Area Drain Main Drain Fee _
Water Leader Storm Drain Fee
Sprinkler System Water Sys, Fee
Refief Valve Gas Fee
Vac Breaker
Skimmer
Filter
permit Fee
Total Total Fee 3, Sb