NO PERMIT NUMBER/ 0203 I <F -CWT -7-A, t-, INV IC LOT NO.
NO. STREF.I'
�L�Y OF FO
/NOV ?n 1�6d
Date _, 196_
R PLUMBING PERMIT
CUPERTINO
CAppl'ca l?dn is��ty�the City
P'A'
and/or fixtures hsied tfi`FKe reverse
and/or hxtures in accordance with the pre
Cupertino, applicable I
Use of
CONTRACTOR,
State Licens �'���
Sanitary No.
Permit No
c0
Pee $ �
f Cupertino for a permit to install plumbing
side hereof, and agrees to install said prices
jons of the Plumbing Code of the City f
fEreto.
TQK
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS PEES
Water heater
Si ze
Water Closet
Material
Bath 'Cub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washin Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.SinkBTray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Thain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Cas Fee
Vac Breaker
Skimmer
Filter
4J
Permit Fee
Total
Total Fee