51028 (2) LOT NO.
NO. STK46EI'
C OR PLUMBING PERMIT
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° FEB 968 sanitary No.
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° j Date 1 61L Permit No
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° AP( kTno ❑EpTt } of Cupertino for Permit to install plumbing
`o Pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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° C011ITRACTOR, AGENT
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�' —U PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen §ink Not Conn.
Dish Washer I Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&'fray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee (o 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 o2 CLO
Total 'Cotal Fee 0 a