51226 (2)/0033 I s.i� /Ji<f+ LOT NO, 6�R
,... APPLI TION FOR PLUMBING PERMIT
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z z CITY OF CUPERTINO
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rco �' p- 1g� Sanitary No.
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a U to w / 0, 196_ Permit No.
3 UPee $
wLL CQ 28.50
LL w Appll�� q tihFreby made to the City of Cupertino for a permit to install plumbing
n� �Or'hxtures fisted on the reverse side hereof, and agrees to install said prices
> r and/�i%fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
a Use of Premises
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O CONTRACTOR, AGENT
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State License /,7yyo /
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-I-21-70
`A'pproved
X PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
Units I Fees Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
r7D To Curb
ShowerTo
Pro Lin
.
Lavatories
_
To Existing
Kitch n Sink
X rV 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
Material5vt&,—
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
/'>7 Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief V.1ye
Fe,,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee D�
Total ITo[al
Fee p