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NO. Sn EF.I'
A'P LICAT,ION" F.OR PLUMBING
OIi WPPERTIN0
. Ilt ..
NO.
PERMIT
!JUN 11196 l I Sanitary No.
Date 96— � Permit No j1,
n17\1 Or ^i ln� TI I Fee $g2 7
Application is'hereby•made to" eRrtyfof�upertino 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 in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
n
Use of
CONTRACTOR, AGENT
Phone_.? f AI'V
i
State License
Address E^ t_ ->
Address'
Approve
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I FEES
Shower I 1 11 To ProD. Line
Dish Washer Sewer Box
Waste Disaosal
Size
Comb.Sink&Tray I 1 11 To Curb
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTA H FS
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader'
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
,Cas Fee
Vac Breaker
Skimmer
F' ter
Permit Fee
Total 7
j 5 Total Fee 7, p