51125ADA.) CRY OF CUPERT�'d0
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WATER DEKf CITY OF CUPERTINO JUL 11971
" < jot. APjWi�ATION FOR PLUMBING PERMIT / 0
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0 a Date � - ( 19 Permit No
3 LL tY Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
o < 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
a w Cupertino, and all other laws applicable thereto.
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Use of
Premises
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Owner
Address
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CONTRACTOR,
AGENT
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Phone
5[ 2 3
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State License
Approved WILLIAM D. RFgtlCtnr-
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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
Itchen 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
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee %
Area Drain
Main Drain Fee
Water Leider
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Refief Valve
11
Gaq Fee
Vac Breaker
/
Skimmer
Filter
/
Pool Sweeper
Permit Fee
Total
Total Fee 41,