51123�� 7 / I X /l", /-' LOT NO.
NO. STREPT
APPLICATION FOR' PLUMBING PERMIT
z Z ' CITY OF-CUPGRTIA ,�11
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tSEP 23 196'mtary No.
0 Date / 7 196Y Permit No 2---3
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0 Application is hereby made to the City of�Cuperti o.foria permit to install plumbing
o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 1- 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.
,. Use of Premises
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a o e0 State License. -.;?, "q�� Approved
_U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater i. Size
Water Closet Material
Bath Tub To Curb
Shower To Proo. Line
Kitchen Sink
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
DrinkingFountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water header
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee a �t
Total
Total Fee