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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