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O CONTRACTO AGEN
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NO/111 �STA'EFT COT NO. �
y1 APPLICATION FOR PLUMBING PERMIT
f sy CITY OF CUPERTINO
,` h 1 Sanitary \'0.
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e ��n R� 196— Permit No S --/I 1Z.G
G�T Fee$ ZS'60
1 Fation is hereby made to the City of Cupertino for a permit to install plumbing
(ANpes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
�J and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all otherl4iws applicable thereto.
Addr
Approved v _
XPLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
Units I Fees
Units Fees
Water Heater
7J
Size
Water Close[
Material <
Bath Tub
To Curb
Shower
To Prop. Lined
Lavatories
To Existing
Kitchen Sink
/,JZ
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
Materia t
Sand Trap
TOTAL FEES
Urinal
Fixture Fee „(7J
Area Drain
Main Drain Fee 4-01w
Water Leader
Storm Drain Fee
Sprinkler System
11
Water Sys. Fee
h1 -V
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee >--V
Total
y—
Total Fee ,