51205 (3)oro
0
No.
CRY OF CUPEAfnet
NATER DEPT.
ti t D 2 1971
Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
PD
ru
Date , 199
Sanitary No.
Permit No`S/'2-0 J
Fee $ Ls2
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
Owner '7401) 8 r LL
By 'iG c%N11 —C-
' �Coontractor, Agy
Phone ,;7 70 ,)
State License�.S
� .�vvvj� cftt —
GG6G'
70 7
ViFiLLIAM D. r=-N'ZV1Ci
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
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 TrapL
FEES
Urinal
KFixtureFec
eArea
Drain
FeeWater
Leader
in FeeSprinkler
System
Fee
Relief Valve
11 Gas Fee i
Vac Breaker
Skimmer
Filter
r
Permit Fee
Total
Total Fee :i r%