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APPLICATION FOR PLUMBING PERMIT
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z a CITY OF CUPERTINO
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= U IJUL 311970
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" 0 Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and/or f tur �(gg�{{��pp ���c�yyeverse side hereof, and agrees to install said prices
> and�ftiTt� tuEcrin C�rG�I��N�Jhe provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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3 Owner Qti E2 Address >'y i`/��=o.c/> /J�✓o
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O CONTRACT A, AGENT
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ao[LState I-icens�6 �S/6 Approved
U PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
Units I Fees Units Fees
Water Heater Ov Size y /
Water Closet Material .1.
Bath Tub / To Curb
Shower s- To Pro . Line
Lavatories Y,5 To Existing
Kitchen in i'i Not Conn.
Dish Washer
Waste Disposal
Wash Tray / /J' 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 11 ,' /
Restaurant Sink Material k—,".
Sand Trap TOTAL FEES
Urinal Fixture Fee I /hl 6"0
Area Drain Main Drain Fee
Water Lea erStorm Drain Fee
Sprinkler System Water Sys. Fee /J�
Relief Valye 11 Qaq Fees G
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total iB" Total Fee ®.