51231.13
No. S eet Lot No.
CITY OF CUPERTIRO.
WATER DEPT, APPLICATION FOR PLUMBING PERMIT
a U G 9 1971 CITY OF CUPERTINO
%� J/ Sanitary No.
JatC ®��� 19�� Permit No..5/.5
Fee
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. P ��
Use of Premise
Owner
r
By
C ntra
Phone
State License
Approve
Plumbing Inspector
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units
IFees
Water Heater I
Size
Water Closet
Material
Bath Tub I
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tra
STORM DRAINAGE
Wash" 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 3
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
. S
Area Drain
Main Drain Fee
Soo
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
j
( O
Vac Breaker
Skimmer
Filter
Permit Fee
. p
Total
Total Fee
_ S Q