100244 (2) /9 f I GIS J LOT NO.
No. 5'IT -
� CITY OF CUPERTINO
" a AICION FOR PLUMBING PERMIT
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o Sanitary No.
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3 U Fee $ �
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 1-- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all oth Is applicable thereto.
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Use of Premises
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- 3 Owners Aw.lww Address VeZ
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CONTRACTOR, AGENT
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Approved
-U 1 PLUMBING INSPECTOR
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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 19401 WATER SYSTEM
Hopper 4ZO 1 Size
Restaurant Sink nFixtureFee
Sand TrapFEES
Urinal Area Drain e .�Water Leader eeSprinkler System e ,
Re]qef Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper -
• Permit Fee .0'b
Total Total Fee