100185 14
No. Streed Lot No.
o —
v APPLICATION FOR PLUMBING PERMIT
E'
E CITY OF—CUPERTINO
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i�
Sarutary No.
WT11"
s IUate ��— I tPermit No'�JU
A14 1968ra
3 F c e S
Application is hereby made torhe City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reve;se sidlihereot and.agreek[tojinstall said prices and/or fixtures
.; in accordance with the provisions of the Plumbing Code of theCity of Cupertino,and all other
laws applicable thereto.
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m Use o(Pre ices _ n
o ° Owner U Address IW9'-2r
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By Address
3 . Q ntractor,Agent
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v ° Phone /f,(/ --� ��c/
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-a State License Approved J ,
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Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Z, Material
Bath Tub To Curb
Shower J 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
Restaurant Sink VMain
Sand TrapAL FEES
Urinal ee
Area Drain n Fee
Water Leader ain Fee
Sprinkler System .Fee
Relief Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee