NO PERMIT NUMBER (2) LOT NO. / /I
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�•/d �� PLUMBING PERMIT
Z. z 27 196�ITY CUPLRTINO
xo Sanitary No.
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0 pate I9 Permit No
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3 LL Fee $
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the 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
<w Cupertino, and all other laws applicable thereto.
LL Use of Premises
00
oOtwnerC - Address-UA—
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O CONTReTOR,AGENT
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x^ o7.3�q—S� Approved G� I
i State License �/ �•
Ti ^ PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Z I / s o Size ,(I
Water Closet oZ -4.0 ° Material G.
Bath Tub /'S a To Curb
Shower /',50 To Prop. Line
Lavatories o.L. .3 'O To Existing
Kitchen Sink J'_ / -D Not Conn.
Dish Washer / - Sewer Box
Waste Disposal -
Wash Tray STORM DRAINAGE
Washing Machine / I.,fd Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink$Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size " SU
Restaurant Sink Material a
Sand Trap TOTAL FEES
Urinal Fixture Fee 3 Sd
Area Drain Main Drain Fee 11
Water Leader I Storm Drain Fee
Sprinkler Valve Water Sys.Fee .5',)
Relief Valve Gas Fee So
Vac Breaker
Skimmer
Filter
Permit Fee om
Total / So Total Fee So