51003 PLUMBINGFIXTURES
NUMBER
MAIN DRAIN
Units
Fees
Units
Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Pro . Line
Lavatories
I
I To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM.DRAINAGE
Washing Machine
Size
Water Softener
11
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
Gnq Fe
i c=�
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
Total Fee
��
��.:7 ��/Y �,� �" ► 'Q-� LOT NO.
NO. STREFT
CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
INN OP CUPERTINO
WATER DEPT. Sanitary No.
l�•;�� ` �— 19 V Permit No. �/ 0 d
Fee $ &
pl ti+ iDereby 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.
Us= of Premises
Owner %�i'�5 !/J4L; /Y,f/AMIVI ' S Address / D�3
By_E,(a/Z .%ilk/�� CU— Address
CONTRACTOR, AGENT
Phone
State License rs3 z";'_ Z` Approved
jV
PLUMBING INSPECTOR �l
Bldg. De,
Office Copy
BUILDING INSPECTORIS OFFICE
CITY OF CUPERTINO
:5—!� s I?
F1 Sewer Connection Sanitary Permit No. . ................................
umbing Final Plumbing Permit No. ....
........
. .....
Lot No. ------ • ---------------
Owner
-------------
Owner or Tenant --------- .................................... �((
-- -------------------------------
At ...........I--- - —------ .
.
........
... ------------------------
... .. .
Tract ---------------------------- ....... ..... to--6 .... ..........................
Date Connected ------------------- ........... ...... --------W................. .
............... 19%3......
DateFinal -- ---- -A -------------------------------------------
-----I.... . .....
19.�t—.- PLUMBING I�N�SPE
Ill 7/63-1M