Plumbing Application LOT NO
NO. STREET iei
APPLICATION FOR PLUMBING PER T
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Application is hereby madq to,the ay 0{Cupettin� for a permit to instal( plumbing
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0 a pipes and/or fixtures Iisted�onrthe reyerselsi�le, &Mof,,and agrees to install said prices
r 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.
,. Use of Premises ����✓ F-��
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O �_1iG� Address,
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O CONTRACTOR, AGENT
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p 3J WILLIAM, D. +�f]^JI
ao State Liceusea3o A Approved n /
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Nater Ileater Size
Water Closet Material
Bath 'Cub 1'o Curb
Shower To Prop. Line
;07—
Lavatories To Existing
Kitchen ink Q/ Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 7/ Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATE SYSTEM
Hopper Size/
Restaurant Sink Material C/
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee Q-O
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 2.
Total Totul Fee