NO PERMIT NUMBER (3) do/ LOT NO. /
ilvh.�� STREET
APPL•IOATION FOR PLUMBING PERMIT
0,116 (� ; CITY OF CUPERTINO
r1p60 sanitary i\'o. lo.�-
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0 ' Date 196— Permit No
3 n Pee S
ONE
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� Application is herebymade' to the City 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
r r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all ier laws applicable thereto
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¢ Use of Premises
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3 Own ' Address
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CONTRACTOR, AGENT
State License 7So Approved
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I I - U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Nater 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 S'T'ORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&'Cray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Ilopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee 00
Water Leader Stolen Train Fee
Sprinkler Valve Witer Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 00
Total 'Total Fee QO