NO PERMIT NUMBERO .5-0 O I y�+ au�� u/C t, C LOT NO. 7
NO. STREET ,-0[
ION FOR PLUMBING PERMIT
CITY OF CUPEiRTINO
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w ®SEP 1 Sanitary No.
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o • J�te / +. 1960' Permit No
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w LL Fee $ ;27 0 0
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�(�(13tiop�updcd 11 to the City of Cupertino for a permit to install Plumbing
`o � C�lpes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
>a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all ther laws applicable thereto.
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a Use of Premises
o0' rW ry ^- ti U • J Address
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O CONTRACTOR,AGENE
- 0 Phone
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a State License �� 53 �- Approved
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—0 k� PLUMBING INSPECTOR �/
FIXTURESNUMBEN �� MAIN DRAIN
UNPCS FEES _ UNITS I FEES
Water
To
Kitchen
Dish WE
Waste C
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material LU.
Sand Trap
TOTAL FEES
Urinal
Fixture Fee ju..�
Area Drain
Main Drain Fee
4-'010
Water Leader -
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
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Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
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Total
'Total Fee
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