NO PERMIT NUMBER (7)/kyr I; � J LOT
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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Sanitary Nu.
Date �'� O 196 AM' �`" n
Application is hereby made tOhAfN�3,,
ity of Cupertino for Parmit to install plumbing
pipes and/or fixtures listed on '�sije�hc666 an rees to install said prices
and/or fixtures in accordance wovisions of the Plumbing Code of the City of
Cupertino,laws aPP and all < lica t eto.
xRTINO
Use of Bremises l) f
Ph ,e /.�-07
State L* 0
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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
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
0 Material
Bar Sink.
To Alain Drain
Comb.Sink & TrayTo
Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Total