51211/� Y 0- i� I C�
LOT NO.
NO. STREF.
APPLI TION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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Sanitary No.
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o 19 a Permit No �
�9 Fee $
Rpplication is 0'' "J�� de to the City of Cupertino for a permit to install plumbing
w, pipes and/o;`ISSted on the reverse side hereof, and agrees to install said prices
r accordance with the provisions of the Plumbing Code of the City of
a C p �6lno, nd all other laws applicable thereto.
AN
1-4 Use of Premises
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3 CONTRACTOR, AGENT Z
0 Phone ::: Q41-97//
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State License �zGl..r�2 Approved
PLUMBING INSPECTOR
FIXTURES
17UMBER 11
MAIN DRAIN
Units Fees 11
Units Fees
Water Heater
-
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
k
To Main Drain
Sink &Tray
To Curb
Unitng
Fountainrain
WATER SYSTEM
r
g
Size
rant Sink
Material
ra
TOTAL FEES
Fixture Fee
rain
Main Drain Fee
Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
11
Gag Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee C:p
Total 1
Total Fee 1p:w