51001.2 7 6 / LOT NO.---'- CJ
NO. STREET
"nN ' PAPLIC TION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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xDEC 6197 �_� sanitary No. s�s3
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° a Date �� / 196e:'! Permit No 6-/ o v A Z
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Fee $
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° Application is hereby made to the City of Cupertino for a permit to install plumbing
o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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a Use of Premises
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Address
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, By ��� -^-'/ Address��>" �4
° CONTRACTOR, AGENT
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° s State License Approved '- ' ' '
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—U PLUMBING INSPECTOR ✓
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FIXTURES NUMBER MAIN DRAIN
UNITS1 FEES I UNITS FEES
Water Heater / Size
Water Closet Material
Bath Tub To Curb
Shower / To Prop. Line
Lavatories —To Existing
Kitchen ink / Not Conn.
Dish Washer Sewer Box
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 -a
Area Drain Main Drain Fee �"Oa
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee „d'a
Vac Breaker
Skimmer
Filter
Permit Fee O/�
Total Total bee z 0