51177.1NO. STRE F.T
LOT NO. /
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AP TION FOR PLUMBING PERMIT
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x O Sanitary NO.
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Oa ' t 19ow�1 Permit No S/
�O Fee $
° AIpplicatron is h �i to the City of Cupertino for a Permit to install Plumbing
o a pi 's and/or h ed on the reverse side hereof, and agrees to install said rices
> . and/or hxgy s t accordance with the Provisions of the Plumbing Code of the City of
a w Cup 0o, nd all other laws applicable thereto.
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a Use of Premisesl�J�GJ�C
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3 Ow Address
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O CONTRACTOR, A NT
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Phone
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0f State License / �li��%� Approved �'�'�•
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PLUMBING INSPECTOR
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FIXTURES
NUMBER
MAIN DRAIN
Units lFees
11Units Fees
Water Heater
1—/ 1
11 size e
Water Closet
Material
Bath Tub
/
To Curb
Shower
To Prop. Line v
Lavatories
i
Existing
Kitchen Sink
Dish Washer
Waste Disposal
Wash TrayAINAGE
MMate
WashingMachine
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
-
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
_
Fixture Fee
Area Drain
Main Drain Fee )
Water
D F
Sprinkler System
Water Sys. Fee i
Belief
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee ,
Total
Total Fee