51192.2jojC7 �/✓E� ��
No. Street Lot No.
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N
LICATION FOR PLUMBING PERMIT
E �CITY OF CUPERTINO
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Sanitary No.
Y 1 DaYte -f , 19;/ Permit N04�7/ 70� . a
°pF CUPERTIN Fee $ 9s
3
r C+' ` pplication 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
o b in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.
°a � A Use of Premises 0)
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' ° Owner ddress O ✓F/L �C
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ByAddress -
3 y Contractor, A 9
° Phone % 'y% 3
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+V- State License .Z O — ?�-.vZ.- Approved-
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pproved -
Plumbing Inspector f
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prov. Line
Lavatories
To Existing
Kitchen in
n
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 %
Area Drain
Main Drain Fee.
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
r
Permit Fee n
To[al
Total Fee