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MAY CITY OF CUPERTINO
" < Y 24 1�7,APPLICATION FOR PLUMBING PERMIT
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� Application is hereby made to the City of Cupertino for a permit n install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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Use of Premises
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o Q Owner /o)'� �flyyE1� Address
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Phone c953-4, <-
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a o ,, `State License������E'C Approve
U 3- PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size el,/ l
Water Closet Material C /
Bath Tub To Curb
Shower To Pror). Line
Lavatories To Exi stirs
Kitchen 'n 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
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve 11 Gag F c
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee �O
Total Total Fee d-w