100111 NO. STREF.a' ,
APPLICATION FOR PLUMBING PERMIT
z a C^:ITY OF CUPEiRTINO
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xo '''pI1111 Sanitary No.
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o a Date 1T E �7 VVV / 19(� Permit No /6 U
3 Fee $ 1 fZ
o �A p at is f e�}��++ ee��' he Cit of Cupertino fora permit to install plumbing
'o piphSla d/ fixt�7iSATINf�� reverse side hereof, and arees to install sid prics
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all othe laws applicable ther o.
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LL Use of Premises
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r 3 Owner I-�`�— Address
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CONTRACTOR, AGENT
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as State License 7 Y - Approved 1
-0 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 I Sewer Box
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 Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee- .5�0
Vac Breaker ;t ;ro _
Skimmer
Filter 3 5j
Permit Fee '
Total Total Fee