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APPLICATION FOR PLUMBING PERMIT
�< CITY OF CUPERTINO
z - !APR 11 1068
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Sanitary No.
Ua4e.-- - - 196— Permit No
. • i, '.+ �a��i E D 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 City of
Cupertino, and all other laws applicable thereto.
Phone ] 3 6 S—�C X—
State License
Address
PLUMBING INSPECTOR r�
FIXTURES I NUMBER II MAIN DRAIN
UNITS1 FEES UNITS FEES
Shower I / I /" _ II To Pro,. Line
Not Conn.
Sewer Box
Waste
Wash'
Comb.Sink&Tray 1 11 To Curb
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 Thain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee Q
Vac Breaker
Skimmer
Filter
Permit Fee 00
Total
Total Fee