51193ZO.+79 I SIf.VFRI}OO Aub LOT NO.
NO. STREET
nACATION FOR PLUMBING PERMIT
CITY OF CUPERTINO Sanitary No.
Ig �lutee Permit No S'// 93
Pee $ �. 7
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� �p tih I � the City of Cupertino for a permit to install plumbing
`o Riges �1(((�' fi> f�'���-on the reverse side hereof, and agrees to install said prices
r=� j�o firitUres in accordance with the provisions of the Plumbing Code of the City of
< w Cvpsertmo, and all other laws applicable thereto.
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Use of Premises sTo�P,G CARPET S/{LES
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r 3 Owner Address aJ�
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z By11111-ty!"� w �L /1�1(jINC eD Address 2209 1,/A
O CONTRACTOR, AGENT
— ` Phone
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a o� State License /67J,3 J Approved
PLUMBING INSPECTOR I/
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
WATER SYSTEM
Size
Water Closet
/
Material
Bath Tub
TOTAL FEES
To Curb
Shower
Area Drain
To Prop. Line
Lavatories
Storm Drain Fee
To Existin
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAiNACF.
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 °t
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Skimmer
Filter
Permit Fee v 00
Total 3 i Total Fee 60