51231.1 e / No. S /'et Lot No.
CIT( OF CUPERTINO
ppTER DEPT., APPLICATION FOR PLUMBING PERMIT
E AUG 9 971 CITY OF CUPERTINO
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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
ro in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
I.2 laws applicable thereto.
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° Owner Addres
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3 z�. Contrac r,Agent
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— -a State License_ / 7�0Ar-proved Nom---
,\ �/�-i Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pro . Line
Lavatories To Existing
Kitchen 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 3
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader LStorm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve, 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee b