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APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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Sanitary No.
Permit No. S-/117
3�— w Q Fee $ot4 0
p YfpIlic ation is hereby made to the City of Cupertino for a permit to install plumbing pipes
E 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 Plumbing Code of the City of Cupertino, and all other
c laws applicable thereto.
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n Use of Premises
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Owner (/
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By
3 Contractor, Agent
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State License
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Address �0 3 / /B/' P S //PC
Address
ApprovedWILLIAM D. SENEVICH
Plumbing Inspector
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units I 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
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
LMain Drain Fee
Water LeaderStorm
Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee o2 -*U
Total
Total Fee e