51075.1 )0950 No WOLF6 'KP
a No. Street Lot No.
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APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
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U Sanitary No. E;
d , 19aG Permit No.510 7 S.
Fee $ /p,50
Q OC7�pph4ti�GiJher - ade 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 t revisions of the Plumbing Code of the City of Cupertino,and all other
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— State License Approved
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pmp. Line
Lavatories To Existing
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 , a(7
Area Drain Main Drain Fee
WgtQr Leader Stgnp Draine
Sprinkler System Water Sys. Fee /S O
Relief Valve 11 Gas Fee, < OU
Vac Breaker
Skimmer
Filter
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Permit Fee Oa
Total 2 Total Fee Q. Q