51226 (2)7 LOT NO. ✓ I
NO. STBEEI'
P ,�1 ATION FOR PLUMBING PERMIT
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W •ITY OF CUPERTINO
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° J I e r- V 196— Permit No./Q.QG
Pee $ eg?a
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w A pica is�haj� ff he City of Cupertino for a permit to install plumbing
o a pp.01 d .or, fix � t lhhth`d on t Ie reverse side hereof, and agrees to install said prices
r r and%or fixtures in accordance with the provisions of the Plumbing Code of the City of
Z w Cupertino, and all other laws applicable thereto.
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Use of Premises
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Approved
./ PLUMBING INSPECTOR
burr otr 31341 R
FIXTURES
NUMBER
MAIN DRAIN
Units I Fees
Units Fees
Water Heater
iJ
Size
Water Closet
Materia ,
Bath Tub
To Curb
Shower
Z rb 11
To Prom Line•
Lavatories
V 4Zrb I
I To Existing
Kitchen Sink
N t 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
Sand TrapTOTAL
FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee 10—V
Water Leader
Stonn Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
11
Gag Fee,_
Vac Breaker
Skimmer
Filter
Pool Scvecpee
Permit Fee
Total
-/
Total Fee