51226 (2)3
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AP BI ATION FOR PLUMBING PERMIT
71 ° CITY OF CUTE RTI NO
1 Sanitary No.
Lot No. W
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Apia r R� 196 _ Permit No.AW6
Lrt VV• JR
Fee 5.�_
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 Premises
By
Phone— t Ki pi'
State License/ iik�I
Approved
y Plumbing Inspector
F 1X. C *,wr A k— 9�,'T- 3105,411!-
FIXTURES
1341R
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size IV 4
Water Closet
Material441, 17
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Exi tin
Kitche
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
STEM
Hopper
Restaurant Sink
Sand Tra
L FEES
Urinal
tFixtumFee
Area Drain
Fee
. /b
Water Lea er
FeeSprinkler
System
ee ,
?j
Relief Valve
Gas Fee A
j a
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee