51167.2/a i Sea a _ . .
No. Street Lot No
g �
a �' A.P ICATION FOR PLUMBING PERMIT
E -I CITY OF CUPERTINO
0 IDEC J 1 1S68 Sanitary No.
E -Datev r2 r...i.� , 196S;"� Permit N4 ''c % 1
3- 1: �It '_•1r�i •.:i Fees_
r 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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
'E laws applicable thereto.
Use of Premises �/1
o_ U
° Owner Address
0
__ rn BY Address
3 z Contractor, Agent
° Phone
3 �
— •-�/, State License Z.S 3 3 i�3� Approved
/°v Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To E ' '
Kitchen Sink
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
Sand Trap
TOTAL FEES
Urinal
Fixture Fee . S
Area Drain
Main Drain Fee
Water Leader
Stom Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
/
Skimmer
Filter
Permit Fee *'-jTotal
Total Fee p