51226 (2)Z)4 ( % A� C/� //i3t•�� LOT NO.
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ON FOR PLUMBING PERMIT
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o y�j Satitary No.
o' �- / ! 196— Permit No 5�Z L6
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4 PAA(+ ,licoFn iCUKP h1 W the City of Cupertino for a permit to install plumbing
and/or fixtures fisted on the rcecrsc side hereof, and agrees to install said rices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
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Use of Premises
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oa Owner Address --4:e'% f
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CON CPO AGENT
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a o State License 7LYt5'/
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Approved ariMl/Irp /
N, PLUMBING INSPECTOR w/
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313 9 R
FIXTURES
NUMBER
MAIN DRAIN
Washing Machine
Units Fees
Units Fees
Water Heater
Bar Sink
Size Af
Water Close[
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Material
Bath Tub
Drinking Fountain
ITo Curb
Shower
I IJV
M#�a
I To Pron. Line
Lavatories _..
I To Existin¢
Dish Washer
Waste Dis osal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
11 Material
Bar Sink
To Main Drain
Comb.S ink & Tray.To
Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Materia
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Fe
Sprinkler System
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee Q—v
Total
Total Fee