51067 AD I LOT NO.
NO. =5��® ATI - FOR PLUMBING PERMIT
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Sanitary Nu.
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Date Permit N
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° Ap rt' tin theregjJ m.(!ity of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on ttYW 'verse side hereof, and agrees 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 laws n plicable thereto
,. Use of Premises
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0 Owner 60
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o, By Address 6111 ` cvLzh
- CON'T'RACTOR, AGENT
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PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material GS
Bath Tub To Curb
Shower To Prop. Line
Lavatories 1110 Existing X
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
—
Washing 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 Cc e
Sand Trap TO'T'AL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storrs Drain Fee
Sprinkler Valve I Water Sys.Fee So
Relief Valve Gas Fee e7
Vac Breaker
Skimmer
Filter
Permit Fee 2 a
Total Cotal Fee 12 3-5—o