51001.4a��o�f�_,.. �;1 LOT NO ,� — 70
Nn. APPL�ICATI- FOR bPLUMBING PERMIT
,CIT F CUPERTINO .71
xo JUL��.b L Sanitary No.
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Date - � 1�6�, Permit No
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Fee
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r o Application is hereby made to the City of Cupertino for a permit to install plumbing
o 1pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
1- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises -
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oa Owner - Addres<�
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J O CONTRACTOR, AGENT
3 � C077
Phon
o LL State License � � S -3` - Approved /
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IF PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
Area Drain
UNITS FEES UNITS FEES
Water Heater
Size
Water Closet
Material(f.
Bath Tub
To Curb
Shower
To Pro .Line
Lavatories
1110 Existing
Kitchenink
Not Conn.
Dish Washer J
Sewer Box
Waste Dis
Wash Tra
S'CORM DRAINAGE
'Washin 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 I
urinal
1 11 P Ixture Pee I
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water s. Fee,
Relief Valve
Gas Fee
Vac
11 Permit Fee .0
Total r tal Fee