51167A176
NO. STREET
LOT
APPLICATION FOR PLUMBING PERMIT
® G Y OF CUPERTINO
Sanitary No.
Date/FIR 1 Wo Permit No 7
Fee S
A(ihR2�yiorY�she(eby the City of Cupertino for a permit to install plumbing
pipes'and%or�fixttur�9Ws c ���i��verse 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 Premises
+� /
Owne/hS� 27�zeAddress
By Address
CONTAACTOR, AGENT
Phone �hr,a5-R e)3Y-!V
State
Approved /JA�I^ z
11i�
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 Existin
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash TraySTORM
DRAINAGE
WashingMachine
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
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Brain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
( 3'a
Gas Fee 5?
Vac Breaker
!' i
Skimmer
s
Filter
( s.
Permit Fee a- °
Total
Total Fee 3 S�