NO PERMIT NUMBER /v 97 I C/iL 0't4i 'K LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
< l ITY OF CUPERTINO
r ° Sanitary No.
� LL 9SEP 19 1 �
0 a Date I96— Permit No
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A Iipt,ionr--here"fiyjRif'ffilie�City of Cupertino for a permit to install plumbing
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0 1 pipes n8/or x ures hste r the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all laws applicable thereto.
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W Use of Premises
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O CONTRACTOA, AGENT
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s State License as S-'s 3 j- Approved WILLI^.P.7
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U PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closet Material
Hath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink N / Not Conn.
Dish Washer Sewer Box
Waste Dis sal
Wash 'I'ra 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
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee Q
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
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Permit Fee '�..•
Total Total Fee