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P FOR PLUMBING PERMIT
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?'L-j oSanitary NoLLPP 1.2g � � 3.
o < U196 Permit No .�
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w _ Fee S 4r7-4v
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jit�cat is Hl7 �9 e City of Cupertino for a permit to install plumbing
o 1- pipes and/or fixtures_lis e nnNl" reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other aws applicable thereto.
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Premises Use ���
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Owner�r� C9.CFF��ri3i r
0 3 �/ 1..L-F�, � - Address
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Dy L' � 'A&Fe�i'° PAC.
3 4 qq CONTRACTOR, AGENT 625 Charles Street
- 0 PhoneQt! a5� can Ince, California 95112
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aRa 777537 Approved
State License ,
j PLUMBING INSPECTOR P/
FIXTURES NUMBER MAIN DRAIN
UN TS FEES UM'rS FEES
Water Ileater Size
Water Closet Material
Bath Tub To Corb
Shower To Prop. Line
Lavatories 'po Fxiatin
Kitchen ink 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&Tmy To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TO'T'AL FEES
Urinal Fixture Feesa
Area Drain Main Drain Fee fl
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee S
Relief Valve Gas Fee .3�
Vac Breaker
Skimmer
Filter
Permit Fee v2
Total ,3 Total Fee