51226 (2)z a
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£ O
/ V0—L_rL I LOT NO. �J
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P ATI FOR PLUMBING PERMIT
CITY OF CUPF.RTINO
S:In 1[:IfV No. --��-
)a �� 196_ Permit No 5111) 2G
C� Fee 5 29.50
Applic Is hereby made to the City of Cupertino for a permit to install plumbing
pipes d is
listed on the reverse side hereof, and agrees to install said prices
an�xtures in accordance with the provisions of the Plumbing Codeofthe City of
Cu rtino, and all other laws applicable thereto.
Use of
Owner
Add
o By Address"/OOGUI�*t[SCg�.I:
3 F n CONTRACjOgR, AGENT Jj
— W PILOne_ /� / i'� `� .. • D c�LL
7o�•✓ ✓
a £ State License ,L� Approved'
—� �C PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
units I Fees
Units Fees
Water Heater
Size c
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line,--
inedLavatories
Lavatories
To Existing
Kitchen in
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
11
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee . O
Area Drain
Main Drain Fee . 6'Z
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
O
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee yi/'D
Total
— �'
Total Fee