511764/
LOT NO.
NO.
APP ICATION FOR PLUMBING PERMIT
C:I OF CUPERTINO
�i�G�7t� Sanitary No.
Date 111 _ Permit No
Fee 5
AptgiAn 'creW,itk{i�ib jjN&ty of Cupertino for a permit to install plumbing
pipes drr fiifrres itHi�jbjUt'�ddjerse 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
By I&kirAC
CONTRACTOR, AGENT
Phone
State License
Address
Approved AV
PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
Sewer Box
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
Drinking Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water Leader
Sprinkler Valve
Relief Valve
Vac Breaker
Skimmer
Filter
Total
STORM DRAINA
Si ze
Material
To Main Drain
To Curb
WATER SYSTEM
Si ze
Material
TOTAL FEES
Fixture Fee
Main Drain Fee
Storm Drain Fee
Water Sys. Fee