NO PERMIT NUMBER ,[ ,3�1u I� ti/�I LOT NO.
NO. 1 MEEI'
APPLICATION FOR PLUMBING PERMIT
d e CITY OF CUPERTINO
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x o Sanitary No.
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3 a I.,' / 19W Permit No Jam_
_U Pee $
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0IT"App4ic'at' made to the City of Cupertino for a permit to install plumbing
o prpcyy��,d`/ p t i� n the reverse side hereof, and agrees to install said prices
i in and/or fixtures m accorc ante with the provisions of the Plumbing Code of the City of
a w Cupertino, and all rt Ic laws applica t rho.
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., Use of P ises
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3 Owner
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R deer Approved
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PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS1 FEES 11 UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
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
Sand Trap TOTAL FEES
Urinal Fixture Fee G
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
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� Permit Fee �—
Total oe Total Fee 3