51121 LOT NO.
NO. ST1 lF
?JUL '8
M? 31tTI'd FOR PLUMBING PERMIT
' 1Y OF CUPERTINO
x o 199 _ Sanitary No.
o ' Date 196 U Permit No
3" CITY OF CUPERTINO s�
w Fee S�
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the 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
a w Cupertino, and all other laws applicable thereto.
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U 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 Sewer Box
Waste Disposal
Wash Troy STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Troy 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 Valve Water S s.Fee
Relief Valve Gas Fee ST
Vac Breaker
_Skimmer
Filter
Permit Fee 0
Total an Total Fee