100179 13 •_( ��/� ���per/ LOT NO.
NO. STREET
�PL�IC�/I�TIO� N.FOR PLUMBING PERMIT
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Sanitary No
.L 1, T68 .
3 0 a Date ((��'' ''pp DDT, 1I9p6� Permit No 7
0 Application is'hcreBy V e�tbT�,2��ty of Cupertino for a permFee it to install
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> < and/or fixtures in accordance with tions Of the Plumbing Code of the ;ity of
i w Cupertino, and all other 's ap art r
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Use of miser
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-0 PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water [cater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories 1b Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
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 WA'T'ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
S rinkler Valve Water Sys.Fee
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total L12tal Fee