51145 Cis I �hew��edirt sT.
LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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Sanitary Nu.Permit NoFee $OApty of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/ yT.ur pt ftp p� e provisions of the Plumbing Code of the City of
a w Cupertino, ang'all I RC PERT I`j able thereto.
LL Use of Premises
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By C , J . T#J rYj 12-rd V Address
J CONTRACTOR, AGENT
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a o State License ApprovedL
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—U, 1 PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
ONITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories _ To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Troy STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To-Main Drain
Comb.SinkBTray 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
Sprinkler Valve Water Sys.Fee
Relief Valve as Fee _
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee