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No. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
m Sanitary No.
Date C 62 Permit No
0U 6 967 1 t. Fee $ r'�3 S'Z�
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipetgVr'dfurrW jgverse side hereof, and agrees to install said prices
and ii fi�{{to m 55 hlltthhe provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
WILLIAM D. BENEVICH
State License Approved 1/1
KPLUM13ING INSPECTOR
_ FIXTURES
NUMBER MAIN DRAIN
Waste Disposal
UNITS FEES UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
/ To Curb
Shower
/ To Prop. Line
Lavatories
To Existing
Kitchen Sink
/ Not Conn.
Dish Washer
Sewer Box
Waste Disposal
_
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&Tray
To Curb
Dental Unit
Drinkin 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 Valve
Water s. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee