NO PERMIT NUMBERmoi/ w qyj I az,- L/ A LOT
NO. ST0.EF.i'
QM 1r—ATJ FOR PLUMBING PERMIT
IOF CUPERTINO �_� vh
Sanitary No. (�C2l
Date 19 IqRR� Permit No
Pee $ 7-- O d
Al lgl5jbn er}Dr�gj ptp�Wit), of Cupertino for a permit to install Plumbing
Pit) r ure 1�1 k �Y�4lsersc side hereof, and agrees to install said Prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner
By , �,ps L i Alc f
CONTR CTOR,AGENT
Phone 3 Zi�� L X.0
State License -2 2I .cy --.
Address 2 O Wefy .a-
Address4i Iii— e-,-,'. ;1-'t
Approve
PLUMBING INSPECTOR /
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Ileater
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
Drinking Fountain
Floor Drain
11 WATER SYS'T'EM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee