5118124.
ITT /U/Y_ .f" 7 LOT NO.
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NO. STItper
I�APP�.LC�TFOR PLUMBING PERMIT
WW ������ I ' CUPF.RTINO
Sanitary No.
Date 2 7 I Permit No _r1l J/
Fee S
Applica(ilr�i� hey rPd•hh HtH fc Sd f Cupertino for a.permit to install plumbing
pipes and or fixtur s list Fh@ 1`rSd 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 t_iEn„-, e-
By
CONTRACT GENT
Phone 75- Jro "'I'w
State License-3�9Sa
Address t
Approved C�/✓.Q= -_
i
T /
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS
FEES
UNITS FEES
Water Beater
Hopper
JS e
Size
Water Closet
Material r,41a.
Material C.y
Bath Tub/
Urinal
S °
To Curb
Shower
/
/•S0
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
-v-
Sewer Box
Waste Disposal
-
Wash Tray
STORM DRAINAGE
Washing Machine
/
i_,ti o
Size
Comb.Sink R Tray
To Curb
Dental Unit
Drinking Fountain
—A
Floor Drain
WATER SYSTEM
Hopper
Size a 1
'5-42
Restaurant Sink
Material r,41a.
Sand Trap
TOTAL FEES
Urinal
Fixture Fee / 6-0
Area Drain
Main Drain Fee -!O
Water Leader
Storm Drain Fee
Valve
Skimmer
Filter
Permit Fee
Total Fee