51179• /(J-7�� IL LOT NO. v
NO. STI EEI'
LkdTION FOR PLUMBING PERMIT
D)Y OF CUPERTINO
Sanitary No.
Dat, }J9fi2 Permit No
Pee $ a 3_ 5 t
pIPVt}}�ji tigq�s hfc.4,D .j Tltj. City of Cupertino for a permit to install plumbing
an /o Ixtu 1st I h 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.
0y— U
Phone �i —���-?
State License 79 Approved WILLIAM D. F3ENHVICH
Y\ PLUMBING INSPECTOR
FIXTURES NUMBER
UNITS FEES
Water Heater
Water Closet
Bath Tub /
Shower
Lavatories
Kitchen Sink /
Dish Washer
Waste Disposal
Wash Tray
Washing Machine
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
Drinking Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water Leader
Sprinkler Valve
Breaker
MAIN DRAIN
UNITS FEES
Size 54
Material e,
To Curb
To Prop. Line
To Existing
Not Conn.
Sewer Box
STORM DRAINAGE
Size
Material
To Main Drain
To Curb
WATER SYSTEM
Size
Material
TOTAL FEES
Fixture Fee
Main Brain Fee Gr�
Storm Drain Fee
Water Svs. Fee I A
Permit Fee I
Total 3Sy Tota] Fee �115�