51028 I 6' LOT NO.
NO. E'
N FOR PLUMBING PERMIT
'z -� 1� .ITY OF PLUMBING
7 ¢ Sanitar No.
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4
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Y F r
0 o j Date `�' 196_ Permit No
3 a V
0 C Fee $
w Applica'`q n hereby made to the City of Cupertino for a permit to install plumbing
0 < pipes and �t� fixtures listed on the reverse side hereof, and agrees to install said prices
> I 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.
LL Use of Premises
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$ 3 wne Address_
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3 F COM C R, AGENT
— 0 Phone — T
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\- State License x Approved WILLIAM D. BENEVICH
PLUMBING INSPECTOR
FIXTURES - NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
I-avatories To Existing
Kitchen Sink Not Conn.
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 WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
W Stom Dram F
Sprinkler System Water Sys. Fee
Vac Breaker
Skimmer !
Filter
Pool Sweeper
Permit Fee
Total Total Fee 06,13