6154 io s-
No. Street Lot No.
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v ) �.APPLE CATION FOR PLUMBING PERMIT
EFC 3 ""CITY OF CUPERTINO
`, 1 968 Sanitary No.
E •Uatet' n• J_0 , l q('& Permit No. siryd
3 `-t 4.Ut •_i`(� INC) Fee S, 00
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Application is hereby made to the City of Cupertino or a permit to install lumbing pipes
and/or fixtures listed on the reverse sidehereof;an gre sto-install-said-psi n In pipes
° in accordance with the provisions of the Plumbin od f the City of Cup no dal]other
I.claws applicable thereto.
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m n Use of Premises
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' ° Owner (/' 694&1 Address
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By Address
3 Contractor,Agent i
v Phone
it
" h 7�5 -State License 0Approv
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.S ink&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
Relief Valve Gaq Fee
Vac Breaker
Skimmer
Filter
Permit Fee C2. &L—
Total Total Fee p