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No. Street Lot No.
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GTY OF CVPOITNO
d APPLICATION FOR PLUMBING PERMIT
OR MAR 2 5 1911 CITY OF CUPERTINO p'/
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Sanitary No. +�/ -Z %S
D
AI
E PDate 1196— Permit No/— ��
3° Fee$
z 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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'E laws applicable thereto. ` _cl / yn n
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A n Use of Premises iffiC O
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Owner Address '' el
o -
r; m
ti By Address
Contractor,Agent
m o Phone �J �lzg--2.
State License LO !/ Approved
Plumbing Inspector v
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To P,.. Line
Lavatories To Existing
Kitcben Sink Nnt Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener f 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
Vac Breaker
Skimmer
Filter
Permit Fee —
Total Total Fee —�