51231.1 No. Stott Lot No.
°
CITY OF CUPERTINO, APPLICATION FOR PLUMBING PERMIT
E WATER DEPT, CITY OF CUPERTINO
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ySanitary No.
AUG 9 197
E Dat , 19Permit No.'d /
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3 FeeS- SZ
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 Plumbing Code of the City of Cupertino,and all other
Alaws applicable thereto.
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Use o(Premis .
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° Owner Address
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m By / Address
3 X Contrac Agent
E ° Phone S ' �-
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Stat
e License / 7 Approved
�r' 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
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 �i-
Restaurant Sink VMainDrain
Sand TrapFEES
Urinal l7
Area Drain eWater Leader eeSprinkler System
Relief Valve I Gnq Fee,
Vac Breaker
Skimmer
Filter
Permit Fee . 0.7
Total Total Fee _Q�