51226No. Stree Lot No.
CITY OF CUPERTINO
/017
APPLICATION FOR PLUMBING PERMIT
E JUL 211971 CITY OF CUPERTINO
U 9 �/Sanitary No.
c �OC'f
Date f D , 19R�
E P Permit No.
x
3
Fee$a3•,
t 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
o in accordance with the provisions of the PI bing Code of the City of Cupertino, and all other
c .E laws applicable thereto.
d
o
A n Use of Premis
o_ U
o Owner Address
o
c
By � Address
3 .c Contract , Agenl
o Phone
3/I
n
— � State License� Approved
/� ';"Plumbing Inspector %
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units I Fees
Water Heater
Size
Water Closet
Material (f
Bath Tub
I
To Curb
Shower
I
To Pro . Line
Lavatories
Z
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
WasMng 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 Fe
Sprinkler System
Water Sys. Fee
Relief Valve
I Gas Fee 0
Vac Breaker
Skimmer
Filter
Permit Fee J
Total
Total Fee 0