51167.3No. Street
o —
Lot No.
H
LICATION FOR PLUMBING PERMIT
a
0 oe��� CITY OF CUPERTINO
U, C T 6 1970 Sanitary No.
c
e
E Date ,196_ Permit No',�'—//G -74.
3 CIT
F
Y
OF CUPERTINO Fee S 56'�O
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
laws applicable thereto. ,
Use of Premises
Owner
By
Contractor, Agent
Phone s- 3 - � J r
State
Address
Address
Approved
Plumbing Inspector~• •`i'.
J
7
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Healer
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Pro Linc
Lavatories
To Existing
Kitchen Sin
N t C n
Dish Washer
Waste Disposal
Wash TraySTORM
DRAINAGE
WashingMachine
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 TrapTOTAL
FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
Gag Fee
Vac Breaker
Skimmer
Filter
9�
Permit Fee .i . M
Total
Total Fee