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NO. STREEI'
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CRY OF CIIP'dif010
CITY OF CUPERTINO
AA n� APPLICATION FOR 'PLUMBING PERMIT
f
r o gy 13 1971 Sanitary No.
o a Date p 19 _ Permit No
3 4 r Pee S_
10
Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws a)licable thereto.
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Use of Premises
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O ONTA 'OR, AGENT
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MLLIAM D. BENEIICU
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`�7� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prue. Line
Lavatories To Existing
Kitchen Sink Not C nn.
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 iv
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 System Water Sys.Fee
Relief Valve I GAR Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee IV,i