51175IIS
/063`-/04.6 /
h0. STREE.I'
LOT NO.
-r,APPL-IC--ATION FOR PLUMBING PERMIT
�i=� CITY OP CUPF:RTINO
r 1�{j Sanitary No.
Date SEP 15 i9 s� :� 196— Permit No
�,�,�r Fee $
Peli(ati�,hT, la:dy�"IY"t1�Lhe City of Cupertino for a permit to install plumbing
pipes and/or fixtures is ed on t re 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 Imus applicable thereto.
Use of Premises
Address
Address
WILLi1n4 n
State License 7 301/1 Approved P1-`Iv�•�—_
PLUMBING INSPECTOR v
T 1
FIXTURES
NUMBER MAIN DRAIN
Floor Drain
UNITS FEES UNITS FEES
Water Ileater
Z, Size '/
Water Closet
_
Material
Bath Tub
2 To Curb
Shower
To Prop. Line
Lavatories
To Existin
Kitchen ink
21 Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Gas Fee 70
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material L
Sand Trap
TOTAL FEES
Urinal
Fixture Fee oz s
Area Drain
Main Drain Fee 1!6--
Water
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /
Relief Valve
Gas Fee 70
Vac Breaker
Skimmer
Filter
Permit Fee
Total
,r ,� Total Fee �� r