51075.11 I /V / A r/%F7 (/ A(/E LOT NO.
NO. STREET
LI TION FOR PLUMBING PERMIT
N QAOL
OF CUPLRTINO
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o J Date -� 67J Permit NO /
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z LL Pee $,
O Aorgy he City of Cupertino for a permit to install plumbing
o a pipe�dt>Sd or W>�urNlJ.�e l4�4hverse 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 applicable thereto.
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a Use of Premises
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OCONTRACTOR,AGENT z
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a 1 ? 136 Approved VJiL�'".M D. Z;V�/ICti/
State License -4
PLUMBING INSPECTOR�
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
Lavatories To Existing
Kitchen Sink Not Corm-
Dish Washer
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 TERTFM
Hopper
Restaurant SinkWater
Sand Trap
Urinal
Ares Drain WteradeyDrain FeeSprinkler System
Reli
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 00
Total Total Fee O