51231.1 !N7qAPPLIkCATi1N
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FOR PLUMBING PERMIT, '
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r o Sanitary No.
o Date — 19�� Permit No J—/ 2 3 �-
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w Fee $ tZ
O Application is hereby made to the City of Cupertino for a permit to install Plumbing
o a pipes and/or fixtures llsted'on the reverse side hereof, and agrees to install said prices
> i- and/or fixtures in accordance with the provi ions of the Plumbing Code of the City of
¢w Cupertino, and all other lawsp cable t ereto.
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4 Use of P
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3 Owne Address
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a o State License (P 77�l oApp d!
PLUMBING INSPECTOR
317/0
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater y Size Al
Water Closet jr Material 01 L
Bath Tub To Curb
Shower 5VII To Prot). Line
_Lavatories To Existin
Kitchen Sink
Not Conn,
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine 4,1Z Size
Water Softener Material
Bar Sink To Main Drain
RComb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hoper Size
Restaurant Sink Material
Sand Tra TOTAL FEES
Urinal Fixture Fee S
Area Drain Main Drain Fee
Water Leader Storm D ain Fee
Sprinkler System Water Sys.Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee �a
Total Total Feed