51231.1 /No. St et Lot No.
CITY OF CUPERTINO APPLICATION FOR PLUMBING PERMIT
WATER DEPT. CITY OF CUPERTINO
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AUG 9 1971 Sanitary No.
E 13,0 ���T , 19p1 Permit No. S /3-3/ /
3 Fee S "1-6 �
u 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
0 in accordance with the provisions o;thclumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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Approved
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size L
Water Closet Material
Bath Tub To Curb
Shower To Prop. 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 a
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee -D
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve I Gaq Fee
Vac Breaker
Skimmer
Filter
Permit Fee RD
Total Total Fee -so