51016.1 S—eL IUN /1 Av�J—' LOT NO.
NO. ST
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPF.RTINO -
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O a )j, i 19 jo - Permit No S/o/t; /
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� Applicatio s Otiai to the City of Cupertino for a permit to install plumbing
o a ,��plts ai.�j'or�j � � the reverse side hereof, and agrees to install said prices
> . and/or-hxtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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CONTRA R,AGENT
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a � State License �� 0 �% � Approved_
PLUMBING INSPECTOR 1
FIXTURES NUMBER MAIN DRAIN
Units I Fees ii Units Fees
Water Heater Size
Water Closet +" Material t'-t
Bath Tub To Curb
Shower /r-r' To Prom Line
Lavatories 6 To Existing
Itchen Sink /"0Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material C;; .
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee /
Area Drain Main Drain Fee �f
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee f
Relief VGaCFee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee