511791419
NO. STREET a
PP.LICATMR' FOR1 PLUMBING PERMIT
tF'CUPERTINO
Date Jl1Llfi81968 195_/ Permit No.
C'TY OF CUPERTINO Fee $
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 in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of
r mow.'
PLUMBING WSPECTOR
I --=rJRES I NUMBEMAINDRAIN
UNITS FEESUNITS
FEES
Water Heater I ' Size
'
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink s Traysl
111 To Curb
Dental Units
I I ii
Drinking Fountains)
II
Floor Drains
_
( WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
Area Cirr-ainsl
1 II Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler Valves
Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE
RECORD OF INSPECTION