51129W
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/ � e`er I 4t, LOT
NO. STMET
TION FOR PLUMBING PERMIT
®Y
OF CUPF.RTINO
Sanitary No.
Dat t UL 10 1 {q6— Permit No .5//ct9
Fee $ sem_
fflitti hi s L)F sQlpfgl%joe City of Cupertino for a permit to install plumbing
pip'eV and/1xtu s t reverse 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
CONTRACYOR, AGENT
Phone Q `,el 93 7 `a
Address Gof
State License") Approved
l.0
PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
Isize
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 Troy
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
I WATER SYSTEM
Hopper
Si ze
Restaurant Sink
Material
Sand Trap
TOTAL 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
Total