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Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
_.. \ --
,Sanitary jo.,,: 'a
Date 1196— -l+ -I`- - t ~ppP'rmut No. //O L
1 UEC 1 9 IJ9DO �, 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 Cityof Cupeitino, and all other
laws applicable thereto.
Use of Premises MdLdEZA
Owner
BY/?!�
Contrraact6r, Agent
Phone
State License
aZ/e
Address
Address
Approved AJ -1--111X 0i
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 Existing
Kitchen Sink
N C nn.
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
Area Drain
Main Drain Fee
Water Leader
Sturm Drain Fee
Sprinkler System
Water Sys, Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee