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No. Street
CITY OF CUPERTINO
JUL 21 1971
Lot No.
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APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
DA ' D
ate 4 — 'zL/ , 19t�.�
Sanitary No.
Permit No.
Fee $'3•S -Z)
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
in accordance with the provici,Tns of the Pit bing Code of the City of Cupertino, and all other
laws applicable thereto.
Use of Premis
Owner
By
Cooj�trac�t'
Phone�Z=C
State License
1/ Approved
Plumbing Inspector
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater 1
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line 97
Lavatories
To Existing
Kitchen in
Not Conn.
Dish Washer
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 t/
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
_ U
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
(�
Relief VMye
Gas Fee,
5-0
Vac Breaker
Skimmer
Filter
Permit Fee
_ t.2
Total
Total Fee
0