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CITY OF CUPERTIRO
MATER DEPT.
SEP 24 1971
Lot No. `�
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Dge W , 195
Sanitary No.
Permit No.. S / J' 12,
Fee $.y2
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.
Use of
Owner
By
ContractcWAgent
Phonate'- f —63 3
State License -41L o Ni D
74
Address -.V11-1 C/ < ss -d
v
Address XD,
Approved
Plum ing Inspector
ly
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
/
Size 41^ l �
Water Closet
L
Material Q•�
Bath Tub
/
To Curb
Shower
/
To Pro . Lin
Lavatories
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 4fM,
Sand Trap
TOTAL FEES
Urinal
Fixture Fee % s•
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee /
Relief Valve
Ca% Fee /s
Vac Breaker
Skimmer
Filter
_
Permit Fee
Total
DI
Total Fee