NO PERMIT NUMBER No ,� Lot No.
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N
1NOV. 1�l APP4ICATION-FOR PLUMBING PERMIT
E s ATP L rdTY'OF CUPERTINO
E
HSanitary No.
n'—\/ i� U r t1 1
E Date �Ze�G� /3 11967 Permit No.
3 Fee
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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; v Use of Premises
°
Owner
Address 726 7� � 6"
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By Addres �-
3 Contractor,Agent
3 Phone
-a State License App d - �-
_J� lumbi`nngg Inspector ✓
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size
Water Closet Material
Bath Tub To Curb
Shower, L To Prop. Line
Lavatories 3 To Existing
Kitchen Sink 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 Material
Sand Trap TOTAL FEES
Urinal Fixture Fee a"U
Area Drain Main Drain Fee J •^'fir
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee AS-0
Relief Valve I Ga,Fee S-0
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee / vv