51231.1 _No. Street Lo[No.
° CITY OF CUPERTIRQ
WATER DEF—F,
v (�7 APPLICATION FOR PLUMBING PERMIT
E 1971 CITY OF CUPERTINO
° AUGU
v
P A 113 Sanitary No.
E Date le —O Al , 19p/ Permit Nos
3 Fee is k
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d 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 of;the Code of the City of Cupertino,and all other
'c laws applicable thereto.
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ro A Use or Premi
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° Owner Address
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m By Address
3 ,c ConJacAgent
Phone
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State License Q15��tqr � Approved /
1 j Plumbing Inspector ✓
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater I Size ItL
Water Closet Material
Bath Tub To Curb
Shower To Prot). Line
Lavatories To Existing
Itchen 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 i 3
Restaurant Sink Material G u
Sand TrapTOTAL FEES
Urinal Fixture Fee �.
Area Drain Main Drain Fee . OJ
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee v
Relief Valve 11 Gaq Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total OX.SC Total Fee