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APPLICATION FOR PLUMBING PERMIT
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o Date Permit No
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Application is hereb- made to th City of Cupertino for a permit to install Plumbing
o Pipes pljr'[��/r fires ��i Terse side he -of, and agrees to install said Prices
> and i. t resm1acmr ice wrt t e Ii o o e Plumbing Code of the City of
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Cupertino, and all icr�laws aphlicab the o.
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Use of Premises
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, 3 Owner Address
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GO `TRACTOR AG T
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otare License 7- y�l Approved -
U PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Wate'r'Heater 1 11.60Size 5
Water Closet Material
Bath Tub To Curb
Shower To Pron. Line
Lavatories J/ To Existing
Kitchen ink 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 DrainWATER SYSTEM
Hoppe •00 Size
Restaurant Sink LMaterial .4 /
Sand Trap TOTAL FEES,
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve
Vac Breaker
Skimmer
Filter
P of Swee er
Pennit Fee .b0
Total Total Fee