51226C No. Street Lot No.
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OTT OF CUpfRTWO
APPLICATION FOR PLUMBING PERMIT
JUL 211971
E CITY OF CUPERTINO
0
U
P A ' D Sanitary No.
E Date , 19P/ Permit No. 57 /.A3
Y
0 Fee
s 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 P umbing Code of the City of Cupertino, and all other
laws applicable thereto.
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A .ro Use of Prerm
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0 Owner Address. f
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h By Address
3 s Cont for Agent
0 Phone
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State License Approved
„J X Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
(
To Curb
Shower
I
To Prov. Line
Lavatories
L
To Existing
Kitchen 'n
r'
of 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 (ae
Sand Tra
TOTAL FEES
Urinal
Fixture Fee (7
Area Drain
Main Drain Fee . 0i
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
I
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee .00
Total
Total Fee "�. S