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O Date 196,1` Permit No. (-
3
w LL Fee $ �9 3. s�
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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
zm� and''/or-fixtdres`n ar`�Drdance with the provisions of the Plumbing Code of the City of
Qi� Cupeitino, and all �otlier laws applicable thereto.
LOT NO. C;r�
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
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Use of tPremtses
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13
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CONTRACTOR, AGENT
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Phone "� �_3 –Z
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State License ��G �—
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Address "
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Address
'j'JILLIAM D. 0MIE71=1
PLUMBING INSPECTOR /
FIXTURES NUMBER 11 MAIN DRAIN
UNITS FEES UNITS FEES
Shower I / I II To Pron. Line I ✓I I
Kitchen
Machine
Sewer Box
Comb.Sink & Tray I 1 II To Curb I I I
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
, Q
Area Drain
Main Drain Fee
Water Leader
Stocm Drain Fee
S rinkler Valve
{Fater Sys. Fee
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Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
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Total A
I Total Fee
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