51015.2 No. Street Lot No.
Ail eeft�0
d , PTION FOR PLUMBING PERMIT
CITY OF CUPERTINO
fNov 171970
Sanitary No.
c
E C' `YO 196 Permit No.5)O I5.Z
3 Fees .00
s, 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
in accordance with the provisions of the Plumbi Code of the City of Cupertino,and all other
n'E laws applicable thereto.
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� State License / � / �� O Approved
'Plumbing Inspector C/
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater .50 Size "
Water Closet 00 Material `
Bath Tub To Curb
Shower To Prop. Line
Lavatories 'Z� S• 0 To Existing
Kitchen
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 �So
Restaurant Sink Material
Sand Trap TOTAL FE
Urinal Fixture Fee 7.50
Area Drain Main Drain Fee $
Water Leader in Fee
Sprinkler System Water Sys.Fee
Relief Valve Caq Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total 250 Total Fee 6