512201No.,2/,*g StreetLot No.
APPLICATION FOR PLUMBING PERMIT
CRY OF CUPUTINO CITY OF CUPERTINO
JUN S 9 9 Sanitary No.
Date k Permit No. -5—/ i Z4
P A, I D Fee 5 OZG Sa
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
in accordance with the provisiopeef the PlurpiSing Code of the City of Cupertino, and all other
laws applicable thereto. l /
�w Use of Premise.
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' ° Owner
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Phone
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1— -� State License
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Approved
Plu�abmg Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units
Fees
Units Fees
;tater Heater
f.,i31
Size
Water Closet
j..
,06
Material
Bath Tub
t3C /3C
To Curb ✓
Shower
To Prop. Line
avatories
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To Exi tin
OKitchen Sinkil
Dish Washer
Waste Dis oral
d Wash Tra
3
STORM DRAINAGE
Washing Machine
. !@j
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 .j
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys, Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
ofg.bl
Total Fee 2Z ./j O