Plumbing Application r
o ;) Lot No.,-,—,
C' �J
a , V rN0V 1 9 196app11GATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
0
OF PUPERTHNO
Sanitary No.
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lid- 'o Bert 8
E Date 1196—
Permit No.
Y
° Fee
3
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 provisions of the Plumbing Code of the City of Cupertino,and all other
"'e laws applicable thereto.
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n A Use of F. rses Dwelling
o � , 2295 De La Craz B oulevard
° Owner Address
° By Palm Plumbing Company Va 34 res Sumly vale-Saratoga Rd.
3 t Contractor,Agent
0 245-2323
° Phone
3
, WlLL7ArN D. t:uVi•=vim.:
-� State License T,.79 Approved •�
V/ Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater to Size
Water Closet t Material
Bath Tub / To Curb
Shower / To Prop.Line d
Lavatories t -7 To Existing
Kitchen / Not Conn.
Dish Washer
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 Materia]
Sand Trap TOTAL FEES
Urinal Fixture Fee /611
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
!—P
Vac Breaker
Skimmer
Filter
=FFeeTotal WSff