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APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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y o f t J ® _ ���� Sanitary No. G
0 a Date G'` 196L'_ Permit No
3�
WLL UL61ssa � Pee $ 1� � � �
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Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes an r. f xt s.Ii sFg (�y�t�jep�� rhe side hereof, and agrees to install said prices
> and/or i 9 it corlla(i�Tfiv'INtlfl TIVIovisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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n Use of Premises
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0 3 Owner /1– .� �/ -i-� Address
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z By CSC/ i"Li c-tl Address
O CONTRAC'T'OR, AGE
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– Phone
RState License"—,' .7 �� Approved'�(�
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PLUMBING INSPECTOR f//
FIX'CURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater Size
Water Closet Material
Bath Tub / To Curb
Shower To Prop. Line
Lavatories i To E�cistin
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 IrOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �6
Total Total Fee Q