51015.2 � I • LOT NO.
NO.
I ION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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a �/j' ��� Sanitary No.
3 a I>/e — 196 �7 A,, Permit No '62 2�
Pee $ O?b o%
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° Applica i��i hereby made to the City of Cupertino for a permit to install plumbing
o a pipes gr{c1 orTixtures listed on the reverse side hereof, and agrees to install said prices
s . andxtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all otFjet laws applicable th�
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�. Use of Premises
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OwnerMNTRACT;OR, AGtNT Address
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af •I State License�/ �'���L Approve
PLUMBING INSPECTOR
FIXTURES I NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
LavatoriesTo Existin
Kitchen ink N t 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 WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee Ar
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Rel ef Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
pool Sweeper
Permit Fee
Total O Total Fee