NO PERMIT NUMBER (3) LOT NO. /
NO. Sn E.E.I'
AYA141LION FOR PLUMBING PERMIT
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r o ® Sanitary No.
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o a Date 1 _ _ f Permit No
3LL Fee $ --�4 Cc `I -
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A t ip��,�.re�t qty W t y of Cu ertino fora permit to install lumbin
o pipes Sad fi. res W hU�tkdJerse side hereof, and arees to install said prices
> : and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other I ws applicable thereto.
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3 Y CONTRACTOR. AGENT
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w w WILLIAM D. 13ENEVICH
a o State License. � /'s79 Approved
U� PLUMBING INSPECTOR
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_ FIXTURES NUMBER VAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
9'ater Closet L3 Material
Bath Tub / 1'o Curb
Shower / To Prop. Line (/
Lavatories Po Existing
Kitchen ink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tra y STORM DRAINAGE
Washin Machine 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
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee