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FEB 19 1071
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APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
,196
Application is hereby made to the Cit,
and/or fixtures listed on the reverse side
in accordance with the provisions of the
laws applicable thereto. A
Use of
Sanitary No. ,�'����
Permit No
Fee S 4414O^
of Cupertino for a permit to install plumbing pipes
eg#and agrees to install said prices and/or fixtures
1Gnibing Code of the City of Cupertipo, and all other
ByAddress
ntrac o , Agent
Phone Z -/71J
State License Approve
mg 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
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 SinkMaterial
Sand TrapTOTAL
FEES '
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee 2.040
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee