51167.3No. •-'1 t Lot No.
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° 1 -r/DEC 1615h LILAC w O C UPERTIINO PERMIT
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hSanitary No.
Y Date �. �c_S"'�?t-r11 �'t19 Permit No. .h //(o % .3
° Fee W,
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s Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the 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.
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„ ro Use o(Premises
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Owne (�f.,d-,rim /:.r Address
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Address
3 r 'Contractor, Agent /
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State License/�lis7"9 /X pprov&0LLiAht D. ECNEVICH
Plumbing I nspector
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 Sink
Not Conn.
Dish Washer
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
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 System
Water Sys. Fee f j/
Relief Valve
C.., Fee, J
Vac Breaker
Skimmer
Filter
Permit Fee
Total
/
Total Fee