51187.1 (2)No. Street
6W tf CUF9aN0 APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
jAN 21 971
Date I $6 f
v
Sanitary No.
Lot No. 317
Permit No,S /J�9,/%/
Fee $ -2— (�, ST
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 Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.
Use of
Owner
By
Phone -1'/`Y3`3p
State License—/'F&'
Approved
X Plumbing Inspector
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Permit Fee
, �-I'
FIXTURES
NUMBER
MAIN DRAIN
I -,
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 Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee / •3
Area Drain
Main Drain Fee D—O
Water Leader
Storm Drain Fee
Sprinkler System
_
Water Sys. Fee
Relief Valve
Gas Fee Ter
Vac Breaker
Skimmer
Filter
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Permit Fee
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Total // (.fQ
Total Fee
I -,