51121 (2) LOT NO.
STREET
OCT ,APPLICATION FOR PLUMBING PERMIT
d 7 1971 CITY OF CUPERTINO
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3 U Pee $ a�
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� Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
`o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
. I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto. ,.
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LL Use of Premises IOS' - /4r-✓
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3 Owner �� /« Address Ltl J u
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O CONTRACTOR, AGENT
3N Phone 37$-2(0
0�f? State LicenseC'31- 2/0. Z� Approved
af�l . .(N PLUMBING 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 Sewer Box
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 Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee Sp
Vac Breaker
Skimmer
Filter
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Permit Fee �0 0
Total Total Fee "3 S