51137 D t7ZO LOT NO.
N(. STREET'
CITY OF CUPERTINO
z2 CITY OF CUFERTRAPPLICATION FOR PLUMBING PERMIT
m O 4 1971 Sanitary No.
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J U4tN 19 — Permit No.
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A�pliction is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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CONTRACTOR, AGENT
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0 o State License P 9,6 139 K Approved '
—U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
K*tchen Sink Not 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 Trap TOTAL FEES
Urinal Fixture Fee 6
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve / S�—
Vac Breaker /
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee -�