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NO. STREET
APPLICATION FOR PLUMBING PERMIT
O'ITY OF CUPERTINO
J
Icn I SFP C 057 �� Sanitary No.
Date J . 1962 Permit No 116 7/
C`?Y r1 Pee$ 0? S O
Application h'crrteb?r�nh�d�ao-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 provisions of the Plumbing Code of the City of
Cupertino, and all other jaws applicable thereto.
Use of Premises
Owner
State License
Address
�
ddressess
Approved• -
-- --
%C PLUMBING INSPECTOR /
FIX'T'URES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
/
Size
Water Closet
Material
Bath Tub
To Curb
Shower
/
To Prop. Line ✓
Lavatories
.9�
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM 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
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Filter
Permit Fee 2
Total 7 , cf-4—:0 / Total Fee J3.f