NO PERMIT NUMBERW P.
w�
\I
dlq5 I /p /,C . LOT NO.
NO. STREPI
/a IA AP�I�r4TT OR PLUMBING PERMIT
f��r�� Y CUPERTINO
Sanitary No.
Datej 27 ���� I Permit No
Z/ Pee $
A lica r� hQ •� Vjp flit &f Cupertino for a permit to install plumbing
pipes and �i turM listec'i 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--- - --- - - -
Use of Premises
•�- �' -�
OwnerLL -
By - CONTRA R, AGENT
Phone 7—?00
State License —23 0 % �S -22
Address 49.6 o '4
Approved
4- PLUMBING INSPECTOR /
FIXTURES
NUMBER
MAIN DRAIN
UNITS
I FEES
UNITS FEES
Water Heater
/.SO
Size o9
Water Closet
oT
3.o a
Material �..1.
Bath Tub
/-Se
To Curb
Shower
/
/-S-0
To Prop. Line
Lavatories
,vO
To Existing
Kitchen Sink
/
/,S0
Not Conn.
Dish Washer
/
- o -
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/
/.5-D
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size /"
..m
Restaurant Sink
Material � ✓•
Sand Trap
TOTAL FEES
Urinal
Fixture Fee .SO
Area Drain
Main Drain Fee d7c, p
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /.Se
Relief Valve
Gas Fee 1,5-,)
Vac Breaker
Skimmer
Filter
Permit Fee djO9
Total
/3. 'd
Total Fee 23.5-0