51226A490 't! LOT NO. &7
OSTPE 2 1 OG $ R
(CATION FOR PLUMBING PERMIT
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10 CITY OF CUPERTINOSanitary No.
196— Permit Nod,
GPee $ 5.5
ApIt'tion is hereby made to the City of Cupertino for a permit to install plumbing
o 1 p I d/or fixtures listed on the reverse side hereof, and agrees to install said prices
or fixtures in accordance with the provisions of the Plumbing Code of the City of
w(2upertino, and all other laws applicable thereto.
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License
X PLUMBING INSPECTOR `IY/
FIXTURES
NUMBER
MAIN DRAIN
Units IFees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
Ild-bil
To Pro. Line✓
Lavatories
To Existiniz
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size .
Water Softener
Material
Bar Sink
To Main Drain
Comb.S ink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee Ar J�v
Area Drain
Main Drain Fee ev
Water Leader
Storm Drain Fee
Sprinkler System
11
Water Sys. Fee
Relief Valve
I
Gas Fee O
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee o-o
Total
Total Fee