512263
d
No. Street
CITY Of CUPERTINO /,9/
JUL 21 �g71 APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
P A { D —�7
Date 'W , 19�/
Sanitary No.
Lot No. j�
Permit No. 571 16
Fee S ;I3 --;7Z)
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 tie Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.} �7
Use of Premis .
Owner
By
Contr
Phone'
State License
Approved
Plumbing Inspector 4*�'
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Sue
Water Closet
Material G.
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen
t Conn,
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
I Size tag* I
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Ho er
I Size
Restaurant Sink
Material L'
Sand Tra
TOTAL FEES
Urinal
Fixture Fee 13.
S
Area Drain
Main Drain Fee
V `�
Water Le er
Storm Drain Fee
Sprinkler System 11
Water Sys. Fee 1.
S
Relief Valve 11
Gwq Fee,
Sv
Vac Breaker 11
Skimmer 11
Filter 11
Permit Fee 0
J
Total
Total Fee 3.
U