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IsCo /—,LOT NO.
NO. STR I...'
an OF COP#PLICATION FOR PLUMBING PERMIT
MATER Dir . CITY OF CUPERTINO
u G f 2 6 1571
Dat i D —, 19;/
Sanitary No.
Permit No //�9
Pee $J'
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 in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
By Z411,tfc.l ES
CONTRACTOR, A ENT n
Phone e�'e —'mis
State License 2/011Z a
Address-'/�Z/J
Approved
PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
Dental Unit
I1NIT5 FEES 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
Storm Drain Fee
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Comb.Sink R Tray
J1 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 Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skinuner
Filter
Permit I'ee ..Z
Total
Total Fee Z e "v