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APPLICATION FOR PLUMBING PERMIT
1� CITY OF CUPERTINO
Sanitary No.
Dare 196_ Permit No s Z; Z46
S ((��c� Pee $ z $. 50
�.4plitnt on is hereby made to the City of Cupertino for a permit to install plumbing
fl`P s nd%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
Own,A�. xL/cj/ Addresf/ /•4+tce-n.Add
CONTRACTOR, AGENT
Phone,? 7e ,Vl, i)-/
State License L,/ L YApproved • �/+�'V�
I PLUMBING INSPECTOR ✓
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
11Units Fees
Water Heater
Size il
Water Closet
Material
Bath Tub
To Curb
Shower
To Prom Line
Lavatories
3 Ya
To Exist ng
Itchen Sink
IVIO
Not Conn.
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
Drinking Fountain
'
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Materia'
Sand Trap
TOTAL FEES
Urinal '
Fixture Fee r a
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relqe[Valve
11
Ga� Fee f-2)
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
-Lf j 0
Total Fee