NO PERMIT NUMBER LOTNO. /
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z Z i CITY OF CUPERTINO
ro Sanitary No.
¢ LL _� /
O j Date cr It
3U
2 LL
' 0 Application is hereby ma4to 'jiGC�TCjij*,j gor permit to install plumbing
o a pipes and/or fixtures listed on the reverse slide herrn , and
;re to install said prites
i m` and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all oi s aul ie461e r UP�,RTINO
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a Use of Pre ises
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a o State Licence Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITST FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen §ink 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 I WATER SYSTEM
Hopper Size
Restaurant Sink Materiel
Sand Trap TOTAL FEES
Urinal Fixtare Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
SprinklerValve Water Sys.Fee
Relief Valve 11 Gas Fee
Vac Breaker _
Skimmer
Filter
Permit Fee
T,gial ' Total Fee