51167.1LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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r o Sanitary No.
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3 a Date � � 19(%.l Permit No 7,
_ Fee $ 02
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
ow pies and�o4 fixtures listed on the reverse side hereof, and agrees to install said rices
ate. a .a P
r �i Band/otofixtures In accor'dhnie-with the provisions of the Plumbing Code of the City of
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a W ;Cupertino, and all other l s applicable thereto.
a � f'sel o6 PIremisem !I _C-c6e,
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/ Mayr �ru
3Qwne(7 Address
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j z Bvy>>i�X�il�_.ir Address
o CbKTRACTOR, AGENT
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– Phone �.3 — ?
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a WILLIAM D. CENEViCIi
O Y State License �a �� Approved
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- U PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Ileater
110
Size I 4Z
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
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee G'
Area Drain
Main Drain Fee
Water Leader
Stonn Drain Fee J�
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee