51211LOT NO. /-/
NO. _ Y➢rt'Q9l
;WL ON FOR PLUMBING PERMIT
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W¢
QTY OF CUPERTINO
Sanitary No.
7016— Perin it No s 2
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3 LL t Q Fee $��
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Applicati s y made to the City of Cupertino for a permit to install plumbing
o a pipes /o xtures listed on the reverse side hereof, and agrees to install said prices
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Cupyr
>) and i. tures in accordance with the provisions of the Plumbing Code of the City of
a tmo, and all other laws applicable thereto.
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Use of Premises 3 U,,.t
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3 Owner �+�. 0/!-C �' Address
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By Address
3 CONTRACTOR, AGENT
-0 Phone
ww '7-22-70 ulc-4CaA.
aUta[e Liccnsc .2 5 g�O y3 Approved
�//� PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
7—
Material
Bath Tub
(a
To Curb
ShowerTo
Pro . Line
Lavatories
To Exisdn
Kitchen Sink
U
Not Conn.
Dish Washer
'
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
(P
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 / c
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee /115-0
Relief Valve
11
Gaq Fee,_ 3 a
Vac Breaker
$ �..�T.(.S&•
Skimmer
Filter
Pool Sweeper
Permit Fee a . 0 O
Total
S
Total Feed