51001.2 10235 I (�/ ` LOT NO.
NO. STREET
AIR
ACICAL1'- • R PLUMBING PERMIT
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CUPFRTINO� Permit N
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Date 196
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� pplica i �i hc�}�iy t le ity of Cupertino for a permit In install plumbing
'o W pipes and oc Ames listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accce With the provisions of the Plumbing Code of the City of
a w Cupertino, and all er la ,s applicable r
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_V PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
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
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Drain Fee
Water Leader - , Stom"Prain Fee
SprinklerValve t Water s.Fee
Relief Valve Gas F e
Vac Breaker
Skimmer J '
Filter
1
Permit Fee '��
Total Total Fee ��