51134 LOT NO.
NO. STREET
3APkICATION FOR PLUMBING PERMIT
z < q JY OF CUPERTINO
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r a l� ��07 Sanitary No
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0 a D1 1962 Permit No �1/ SG
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w LL Fee $
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OI�pY9ca a {�[Q�q�(�he City of Cupertino for a permit to install plumbing
o pipes and Tfixt�r'eY'IhthUIdBVt'C reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto. -
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O CONTRACTOR, AGENT
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u f State License 23� Approve
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-0 1 PLUMBING INSPECTOR) /
FIXTURESMNpotConn —
Dish
AIN DRAIN
UNITS FEES
Water Heater
Water Closetl
Bath Tubb
Shower . LineLavatoriestinKitchen inkn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener D 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 Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee D 0