51226ZL%aLOT NO.
NO. TI Z1001 R
I ON FOR PLUMBING PERMIT
D
y -ITY OF CUPGRTINO
D ;
Applic�ti�s hF}. made to tf
pip �tfte� or fixtures h ted on the
and'dcfiztures in accordance with
Cupertino, and all other-Aaws app
Use of Premises
State License
Samtary Nu.
196_ Permit No
Pee$ 2'5.50
e City of Cupertinofor a permit to install plumbing
reverse side hereof, and agrees to install said prices
the provisions of the Plumbing Code of the City of
icable thereto.
7 70
Approved
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
Uni[s Fees
Units
Fees
Water Heater
Size
Water Closet
I Material -7
Bath Tub
A rb
L To Curb
Shower
To Prof). Lin
Lavatories
•"
To Existing
Kitchen in
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
• '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
Restaurant Sink
11
Materia r
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
ZJ
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee4,0
Relief Valve
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Db
Total
Total Fee
0