Plumbing Application LOT NO.
NO. STREET
F.I'
APPLICATION FOR PLUMBING PERMIT
" < CITY OF CUPERTINO
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s 0 m S: 3ry No.
o a Date 196 ���mit No
1 1368 `��= Pee $
wLL OCT 8
1 0
Application is hereby ma e to the City of Cupertino for a permit to Install plumbing
o a pipes and/or fixtures listed on the reverse. siclF he fjond agrees to install said prices
> I and/or fixtures in accordancey,ithjIthe p�o�Isi�rislbfj theJPlumbing Code of the City of
a w Cupertino, and all otherkla"'s applicable thereto.
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Use of Premises kl'c�
00
" Addres'' r Q�"t
r 3 Owner
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CONTRACTOR, AGENT `
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Phone ag,-j'-'rF-0 7 7
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0a �31fS�.� - Approved WILLIAM D. NNIGH
o State License
—U V PLUMBING INSPECTOR v
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Beater Size
Water Closet Material
Bath Tub To Curb
Shower y To Prop. Line
Lavatories 7 To Existin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To.Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size 1161
/
Restaurant Sink MaterlalCR (J
Sand'l'rap TOTAL FEES
Urinal Fixture Fee
Area Ikain .Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee JTl
Relief Valve Gas Fee .J
Vac Breaker
Skimmer
Filter
Permit Fee
Total 0 'l'otal Fee