51245 /00 23 So. ff L/ 9
c No. Street Lot No.
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APPLICATION FOR PLUMBING PERMIT
E 01Y of CUKO"o CITY OF CUPERTINO
0
U 91 11Sanitary No. 771> tx17'1A1C.
APR
!�� 45
5 Date ' z 197� 'Permit No5/Z
0 PA
3 Fee $Z100
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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto. -
ro A Use of Premises a'?
051 1 o Own � t Address
V
o0c
ti By Address—
Contractor,
ddress
3 y Contractor,J'gent
0 0 Phone K 09 D
" 4 �� 9
^ State License Approve i
`` Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units I Fees
Water Heater Size o U
Water Closet Material
Bath Tub To Curb
Shower To Prov. Line
Lavatories 1. 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 16'r I
Sand Trap TOTAL FEES
Urinal Fixture Fee •50
Area Drain Main Drain Fee
Water Leader Storm Drain Fee �—
Sprinkler System Water Sys. Fee
Relief V,1ye 11 Cas Fep.
N
Vac Breaker
Skimmer
Filter
Permit Fee 2.00
Total 13 •5C Total Fee